Detecting Delayed Microbiology Results After Hospital Discharge: Improving Patient Safety Through an Automated Medical Informatics Tool

Abstract

). © 2011 Mayo Foundation for Medical Education and ResearchC ultures for bacteria, fungi, viruses, and mycobacteria require days to weeks to produce positive results. For many hospitalized patients, culture results are not available at the time of dismissal. In fact, approximately 41% of patients discharged from the hospital have pending laboratory test results, 1,2 and the most common results requiring urgent action come from pending microbiology tests. Results of a delayed positive culture commonly require initiation of or change in antimicrobial therapy 1,3 ; however, only a fraction of pending microbiology tests are actually documented on the hospital dismissal summary. 3 Strategies are therefore needed to improve both the recognition of delayed test results and the communication of such results to the appropriate health care professional providing care to the patient. Computerized information systems are gaining increasing recognition as a valued tool for reducing medical errors. Computerized tools that can improve communication of laboratory information and assist with monitoring of pending laboratory tests are 2 main strategies that show how information technology can reduce medical errors and prevent adverse patient outcomes. 4 An automated alerting system for inpatient critical laboratory results has been shown to reduce the time until appropriate treatment is subsequently prescribed. 5 However, no published studies have evaluated the utility of automated alerting systems for microbiology test results that are pending at the time of hospital discharge. We developed a computerized medical informatics tool to identify patients who had a culture performed on a sterile body site specimen during their hospitalization that subsequently turned positive after hospital dismissal. During a 13-month period, 533 patients had a positive culture identified by our Computer-Based Antimicrobial Monitoring (CBAM) program after hospital dismissal, and 112 (21%) of these culture results necessitated an intervention and communication with the primary health care professional. Thirtytwo (29%) of positive cultures were from the blood. Thirty-eight (34%) of the CBAM interventions with available outcome data resulted in initiation of, change in, or prolongation of outpatient antimicrobial therapy. The CBAM program serves an important role in optimizing patient care and communication with the health care professional during the transition from inpatient to outpatient management. Detecting Delayed Microbiology Results Mayo Clin Proc. 2011;86(12):1181-1185 CBAM = Computer-Based Antimicrobial Monitoring; ID = infectious diseasesThe Computer-Based Antimicrobial Monitoring (CBAM) system used at Mayo Clinic in Rochester, MN, is an automated, rules-based medical informatics system that monitors antimicrobial and microbiology information among hospitalized patients in near real time. Its objectives are to improve patient care through the reduction of medical errors, enhancement of education for the health care professional, and improve...

Impact of Automated Alerts on Follow-Up of Post-Discharge Microbiology Results: A Cluster Randomized Controlled Trial

“…1 Wilson et al described a notification system targeting infectious disease specialists with post-discharge non-urine microbiology results, but did not evaluate the impact of the system with a concurrent control group. 4 Dalal et al found that hospital-based clinicians recognized the importance of proper test result management, but failed to adopt an electronic test result management 12 To improve adoption, we strove to maximize the likelihood that our alerts represented true untreated infections. In addition, we attempted to aggregate useful information in the alert to enhance the efficiency of result follow-up.…”

“…3,4 Failure to follow up on these results in a timely fashion can delay the diagnosis and treatment of infections, leading to patient harm and risk of litigation. 5,6 The proper communication of test results that are pending at hospital discharge is becoming more crucial as hospitalized patients are increasingly cared for by hospital-based clinicians rather than their primary care providers (PCPs).…”

“…[14][15][16] One study found that 38/533 (7.1%) positive post-discharge non-urine microbiology results that were reviewed led to initiation, prolongation or change of antimicrobial therapy in the outpatient setting. 4 Comprehensive electronic result management systems have been successfully implemented in ambulatory settings; 16,17 however, gaps in test result management remain. 18 Initial attempts to improve inpatient test result management have not shown significant impact.…”

Point-of-care testing by healthcare workers for detection of meticillin-resistant Staphylococcus aureus, Clostridioides difficile, and norovirus

“…Timely, accurate patient sample results are essential in order for this to occur. Traditional microbiology, however, is often culture-based and reportable results can sometimes take days to deliver [2]. Additionally there is a sustainability challenge in microbiology services due to reduced staffing, increasing costs, greater demand for services and a rising ageing population [3,4].…”

Clinical Microbiology Informatics

“…Another option is to use a more hands-on approach in which software flags a chart for review by an infectious disease physician when a result of interest is reported after discharge. Once the infectious disease specialist has reviewed the result and the patient chart, the specialist can subsequently contact the treating physician if a change in therapy is potentially indicated (40).…”