Division of Biomedical Informatics, University of California San Diego, 9500 Gilman Dr., no. 0505, La Jolla, San Diego, CA 92093-0505, USA,
J Gen Intern Med. 2012 Oct;27(10):1243-50. doi: 10.1007/s11606-012-1986-8. Epub 2012 Jan 26.
Failure to follow up microbiology results pending at the time of hospital discharge can delay diagnosis and treatment of important infections, harm patients, and increase the risk of litigation. Current systems to track pending tests are often inadequate.
To design, implement, and evaluate an automated system to improve follow-up of microbiology results that return after hospitalized patients are discharged.
Cluster randomized controlled trial.
Inpatient and outpatient physicians caring for adult patients hospitalized at a large academic hospital from February 2009 to June 2010 with positive and untreated or undertreated blood, urine, sputum, or cerebral spinal fluid cultures returning post-discharge.
An automated e-mail-based system alerting inpatient and outpatient physicians to positive post-discharge culture results not adequately treated with an antibiotic at the time of discharge.
Our primary outcome was documented follow-up of results within 3 days. Secondary outcomes included physician awareness and assessment of result urgency, impact on clinical assessments and plans, and preferred alerting scenarios.
We evaluated the follow-up of 157 post-discharge microbiology results from patients of 121 physicians. We found documented follow-up in 27/97 (28%) results in the intervention group and 8/60 (13%) in the control group [aOR 3.2, (95% CI 1.3-8.4); p=0.01]. Of all inpatient physician respondents, 32/82 (39%) were previously aware of the results, 45/77 (58%) felt the results changed their assessments and plans, 43/77 (56%) felt the results required urgent action, and 67/70 (96%) preferred alerts for current or broader scenarios.
Our alerting system improved the proportion of important post-discharge microbiology results with documented follow-up, though the proportion remained low. The alerts were well received and may be expanded in the future.
出院时未跟进待处理的微生物学结果可能会延迟重要感染的诊断和治疗，危害患者，并增加诉讼风险。目前跟踪待检的系统通常不够完善。
设计、实施和评估一种自动系统，以改善出院后返回的微生物学结果的后续跟踪。
集群随机对照试验。
2009 年 2 月至 2010 年 6 月期间在一家大型学术医院住院的成年患者，其血液、尿液、痰或脑脊液培养物呈阳性且未经治疗或治疗不足，出院后返回。
一种基于自动电子邮件的系统，提醒住院和门诊医生注意出院后未经适当抗生素治疗的阳性培养结果。
我们的主要结果是在 3 天内记录结果的后续跟进情况。次要结果包括医生对结果紧迫性的认识和评估、对临床评估和计划的影响以及首选警报场景。
我们评估了 121 名医生的 157 份出院后微生物学结果的后续情况。我们发现，在干预组的 97 个结果中有 27 个（28%）记录了后续情况，在对照组的 60 个结果中有 8 个（13%）[比值比 3.2，（95%置信区间 1.3-8.4）；p=0.01]。在所有住院医生受访者中，32/82（39%）之前知道这些结果，45/77（58%）认为这些结果改变了他们的评估和计划，43/77（56%）认为这些结果需要紧急行动，67/70（96%）更喜欢当前或更广泛场景的警报。
我们的警报系统提高了有记录的重要出院后微生物学结果的比例，但比例仍然很低。这些警报得到了很好的反馈，并可能在未来得到扩展。
