456. Opportunities to Educate Trainees and Hospitalists Regarding Appropriate Use of Specialized Testing in Hospitalized Inpatients with HIV at a County Hospital
Session: Poster Abstract Session: Innovations in Medical Education
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • IDSA 9-28-2015 small.pdf (1.4 MB)
  • Background: In the era of highly active antiretroviral therapy, fewer inpatients are hospitalized with HIV.  Most HIV inpatients are primarily cared for by physicians without HIV specialization, with or without consultation from HIV-specialized physicians.  Simultaneously, computerized physician order entry allows for physicians to order tests without understanding test indications (“button-clicking syndrome”).

    Methods: All patients hospitalized with HIV at Ben Taub General Hospital, a tertiary care public safety net hospital in Houston, TX, between January 1st, 2014 and June 30th, 2014 were identified.  Patients were admitted to either housestaff or hospitalist services with HIV service consultation.  Laboratory tests which were ordered on every patient were catalogued.  Appropriateness of test ordering was assessed by an infectious disease physician based on prior specified criteria.

    Results: A total of 274 patients were admitted 429 times in the 6 month period.  A total of 19 CMV IgMs were ordered, 15 by teaching services, and 4 by hospitalist services; no patient had suspected acute CMV acquisition.  71 serum qualitative CMV PCRs and 11 CMV quantitative PCRs were ordered; 59 (72%) were ordered by housestaff services, and 23 (28%) by hospitalist services.  Most (85%) were ordered for non-specific signs of infection (e.g. fever).  10 patients were treated for CMV in total (5 for confirmed invasive disease and 5 empirically).  102 Hepatitis A IgMs were ordered; only 25 (25%) were to evaluate acute transaminitis; others were ordered to evaluate chronic hepatitis or for hepatitis screening.  Similarly, only 26 of 198 Hepatitis B Core IgMs were ordered to evaluate acute hepatitis.  Other tests ordered without clear indications included Aspergillus IgE (7), galactomannan antigen (8), serum EBV PCR (5), Parvovirus serology (7), and Toxoplasma IgM (18).  17 HIV Genosure tests were ordered; only one patient had suspected integrase inhibitor resistance.

    Conclusion: Many tests ordered in HIV inpatients on both housestaff and hospitalist services do not have indications.  Opportunities exist to educate both trainees and hospitalists regarding appropriate indications for specialized testing in hospitalized HIV patients.

    Kathryn Bolles, MD, Department of Medicine, University of Washington, Seattle, WA, Laila Woc-Colburn, M.D., Medicine/Infectious Diseases, Baylor College of Medicine/ The National School of Tropical Medicine, Houston, TX, Richard Hamill, MD, FIDSA, Baylor College of Medicine, Houston, TX and Vagish S. Hemmige, MD, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX

    Disclosures:

    K. Bolles, None

    L. Woc-Colburn, None

    R. Hamill, None

    V. S. Hemmige, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.