524. Choice of Test for Influenza-like Illness is Heavily Influenced by Physician Specialty and Preference
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: At the Cleveland Clinic, available respiratory virus (RV) testing options include: FLU (influenza A/B PCR), RSV (respiratory syncytial virus PCR), FLURSV (influenza A/B and RSV PCR), and RVPAN (FLURSV plus parainfluenzaviruses 1-3 and adenovirus DFA). Point-of-care testing is not an option. It was suspected that the test ordered is influenced by physician specialty.
Methods: All adults, excluding organ transplant recipients, who had RV testing at Cleveland Clinic ambulatory main campus and community practice sites during the 2007-2008 influenza season were identified. Demographic and testing data (latter populated as a result of computerized provider order entry) were extracted from the electronic health record database and by chart review. Test ordering patterns for family practice (FP), internal medicine (IM), pulmonary medicine (PM), infectious disease (ID) physicians were examined.
Results: Five hundred and twenty-eight adults without organ transplants underwent RV testing at 38 different outpatient sites. Of these, 479 were seen by FP, IM, PM, or ID physicians, and the tests ordered varied by specialty (table, chi square p-value < 0.001).
Tests ordered by physicians of different specialties
Specialty (number of doctors)FLUFLURSVRVPAN
Family Practice (16)10451
Internal medicine (59)251386
Pulmonary medicine160
Infectious Disease1714

Test positive rates were 0.55, 0.59, 0 and 0.32, respectively, for FP, IM, PM, and ID physicians. Of the 22 IM physicians who ordered 5 or more tests each, only 8 (36%) ordered more than one type of test in their respective patients.
Conclusion: At our institution, the choice of test ordered for influenza-like illness is heavily influenced by physician specialty and preference. Subspecialists tend to order more extensive panels, but with few additional positive test results.
Steven Gordon, MD, FIDSA1, Anil Jain, MD2, Nikole Scalera, MD, MS2, Nabin Shrestha, MD3, Belinda Yen-Lieberman, Ph.D. and  N. M. Scalera, None..
N. K. Shrestha, None..
A. K. Jain, None..
B. Yen-Lieberman, None..
S. M. Gordon, None., (1)Infectious Disease, Cleveland Clinic, Cleveland, OH, (2)Cleveland Clinic, Cleveland, OH, (3)Cleveland Clinic Foundation, Cleveland, OH


S. Gordon, None

A. Jain, None

N. Scalera, None

N. Shrestha, None

B. Yen-Lieberman, None