The Association between the Establishment of a General Internal Medicine Department and an Increased Number of Blood Cultures in Other Departments: An Interrupted Time Series Analysis

Abstract

Objective The establishment of a department of general internal medicine (GIM) has been shown to improve the clinical outcomes among patients treated in GIM departments but the effect on practice patterns in other departments remains unclear. We evaluated the association between the establishment of a GIM department and the use of blood cultures, an indicator of quality of care of infectious diseases, in other departments. Methods This study was conducted between 2013 and 2017 in a community hospital which established a new GIM department in 2015, with a mandate to improve the quality of care of the hospital including infectious disease management. The primary outcome was the change in the number of blood culture episodes per calendar month in other departments before and after establishment of the GIM department. The secondary outcome was the change in the blood culture episodes per month, indexed to 1,000 patient-days, during the same time. Using 2015 as the phase-in period, interrupted time series analyses were used to evaluate the change in the outcome variables. Results In departments other than GIM, there were 284 blood cultures prior to the establishment of the GIM department (2013)(2014) and 853 afterwards (2016)(2017). The number of blood culture episodes in other departments increased by 10.7 (95%CI: 0.39-21.0, p=0.042) per calendar month after the establishment of the GIM department; blood culture episodes / calendar month / 1,000 patient-days increased by 0.55 (95% CI: 0.03-1.07 p=0.037). Conclusion These results indicate that a GIM department in a community hospital can improve the quality of care in other departments.

Infectious diseases consultations from general internal medicine physicians in Japan: A descriptive single-center study

“…[2] Another report showed that it was associated with an increased number of blood cultures ordered in other departments. [13] Due to the shortage of IDSs, ID and GIM physicians should cooperate to promote the quality of care and clinical management in hospitals in Japan. [14] There are some limitations that must be mentioned.…”

How Do We Establish the Utility and Evidence of General Medicine in Japan?

“… 14 The evidence supporting the clinical benefits of GM is currently limited, with most evidence regarding cost reduction and improvement in quality of care derived from small-scale, single-center studies. 15 , 16 These studies cover a range of clinical areas, including improved quality of inpatient care for infectious endocarditis, 17 increased blood culture collection rate, 18 shortened length of hospital stay, 19 improved quality of home medical care, 20 COVID-19 care, 21 compensating for the shortage of specialists, 22 and improved heart failure management. 23 Studies have been conducted on the patient population, locations, and clinical skills covered during GM training.…”