Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Hosp Med. 2012 May-Jun;7(5):365-9. doi: 10.1002/jhm.1902. Epub 2012 Feb 7.
In the acute care setting in a multidisciplinary healthcare environment, the contribution of infectious disease (ID) specialists to overall patient care is difficult to measure. This study attempts to quantify the contribution of ID specialists when consulted for an activity specific to ID practice, community-based parenteral anti-infective therapy (CoPAT).
In February 2010, an electronic form for requesting ID consultations was introduced in the computerized provider order entry (CPOE) system at the Cleveland Clinic. This allowed for easy identification of ID consultations for CoPAT. Hospital records for all patients with CoPAT consultation requests between February 11, 2010 and May 15, 2010 were reviewed for specific defined contributions in the domains of optimization of antimicrobial therapy, significant change in patient assessment, and additional medical care contribution.
Over a 3-month period, there were 263 CoPAT consultation requests via CPOE, of which 172 were initial consultations and 91 reconsultations. Antimicrobial treatment was optimized in 84%, a significant change in patient assessment made in 52%, and additional medical care contribution provided in 71% of consultations. In 33% of consultations, there was contribution in all 3 domains. CoPAT was deemed not to be necessary in 27%. For patients requiring CoPAT, effective care transition from the inpatient to outpatient setting was assured at least 86% of the time.
Infectious disease consultation before discharge on parenteral antibiotics adds value by contributing substantially to inpatient care, and providing antimicrobial stewardship and continuity of care at a critical patient care transition point.
在多学科医疗环境的急性护理环境中，传染病（ID）专家对整体患者护理的贡献难以衡量。本研究试图量化 ID 专家在针对特定 ID 实践的活动（即社区为基础的肠外抗感染治疗（CoPAT））进行咨询时的贡献。
2010 年 2 月，克利夫兰诊所的计算机化医嘱录入（CPOE）系统中引入了用于请求 ID 咨询的电子表格。这使得易于识别 CoPAT 的 ID 咨询。回顾了 2010 年 2 月 11 日至 5 月 15 日期间所有接受 CoPAT 咨询请求的患者的住院记录，以确定在优化抗菌治疗、患者评估的显著变化和额外医疗贡献方面的具体明确贡献。
在 3 个月的时间内，通过 CPOE 共收到 263 份 CoPAT 咨询请求，其中 172 份为初始咨询，91 份为再咨询。84%的患者优化了抗菌治疗，52%的患者评估发生了显著变化，71%的咨询提供了额外的医疗护理贡献。在 33%的咨询中，在所有 3 个领域都有贡献。27%的咨询认为不需要 CoPAT。对于需要 CoPAT 的患者，至少 86%的时间能够确保从住院到门诊的有效治疗过渡。
在开始肠外抗生素治疗前进行传染病咨询，可以通过对住院护理做出重大贡献，并在关键的患者护理过渡点提供抗菌药物管理和护理连续性，从而增加价值。
