707. How Smart is the Chart? Comparison of Urinary Tract Infection-Related Symptoms Recorded in the Medical Record Versus Obtained Through Interview
Session: Poster Abstract Session: UTIs - Epidemiology and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Background: The Infectious Diseases Society of America has called for performance measures to reduce the inappropriate treatment of asymptomatic bacteriuria (ASB). Classification of ASB for research studies and stewardship interventions is often dependent upon chart review. However, it is not known how accurate chart review is in identifying ASB.

Methods: We evaluated the accuracy of chart review compared to direct patient interview for identifying ASB in a 650 bed university-affiliated hospital. For randomly-selected inpatients with urine cultures, urinary tract infection (UTI)-related symptoms and diagnoses were determined through chart reviews and patient interviews.    

Results: Of 52 patients, 31 (58%) were women and 6 (12%) had spinal cord injury. As shown in the table, lack of documentation of individual symptoms was common, and in 4%-17% of instances with absent documentation, symptoms were elicited by the interview.  Seventeen (33%) patients were categorized as having ASB, eight (15%) as having a UTI, and twenty-seven (52%) as having no UTI.  There were no cases in which ASB was misclassified due to lack of documentation or lack of concordance for individual symptoms (i.e., the symptoms were attributable to other causes, were chronic, or were associated with a negative culture).

No. (%)

Chart and Interview Agree

Chart and Interview Disagree

No chart data

Interview = yes

No chart data

Interview = no

No chart data

Interview = chronic

Dysuria

25 (48)

5 (10)

4 (8)

18 (35)

0

Frequency

10 (19)

5 (10)

8 (15)

25 (48)

4 (8)

Urgency

8 (15)

6 (12)

9 (17)

24 (46)

5 (10)

Hematuria

20 (38)

1 (2)

2 (4)

29 (56)

0

Bladder incontinence

5 (10)

1 (2)

4 (8)

39 (75)

3 (6)

Fever

33 (63)

4 (8)

3 (6)

12 (23)

0

Conclusion: For individual UTI-related symptoms, documentation in the medical record was frequently lacking or inaccurate. However, this did not result in misclassification of ASB.   


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Jessica Jones, MD1, Donald M. Dumford, MD2, Sweta Chaudhary, MD3, Curtis J. Donskey, MD2 and Michelle T. Hecker, MD3, (1)University Hospitals of Cleveland, Cleveland, OH, (2)Louis Stokes VA Medical Center, Cleveland, OH, (3)MetroHealth Medical Center, Cleveland, OH

Disclosures:

J. Jones, None

D. M. Dumford, None

S. Chaudhary, None

C. J. Donskey, Optimer: Consultant, Research support
Merck: Consultant, Research support
ViroPharma: Consultant, Research support
OrthoMcNeil: Consultant, Research support
GoJo: Consultant, Research support

M. T. Hecker, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.