2285. The Cross-Covering Resident and the “Full Fever Work-Up”
Session: Poster Abstract Session: Teaching the Future: Education in Infectious Diseases
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • ffwu poster. ID week 2016.pdf (1000.8 kB)
  • Background: When signing out patients overnight, resident physicians typically inform the cross-covering resident on whether to do a “full fever work-up” (FFWU) if their patient has a fever. However, just what constitutes a FFWU and when it is indicated are not clearly defined. This may lead to unnecessary testing.

    Methods: A 12-question survey was emailed to all 142 internal medicine residents at our institution. The survey consisted of questions regarding the definitions of fever and FFWU, how often and in what clinical scenarios tests are ordered, and residents’ perspectives on FFWU.

    Results: 73 (51% response rate) surveys were completed. Greater than 95% of respondents defined a FFWU as at least including blood cultures, urinalysis, and chest x-ray. 53% of those included at least one additional test in their definition. While cross-covering, 69%, 66%, and 48% of respondents reported they “always” order blood cultures, urinalysis, and chest x-ray, respectively, on a patient with a fever regardless of clinical symptoms. 71% reported they would repeat a FFWU on a patient with a recurrent fever after 48 hours, while only 38% would repeat this for a change in clinical status. 88% reported that they “always” or “often” follow instructions on the sign-out, despite 73% stating the sign-out instructions are “sometimes” or “rarely” kept up to date. When presented with a clinical scenario of a febrile, non-septic, patient with known community-acquired pneumonia, 63% of participants thought no additional work-up was indicated. However, after being told the sign-out instructed to do a FFWU, 55% of respondents changed their orders. Only 15% felt their approach to fever as a cross-cover resident was evidence-based and 18% thought it was cost-effective.

    Conclusion: At our institution, a resident’s approach to a fever overnight often includes reflexively ordering blood cultures, urinalysis and a chest x-ray, though the definition of a FFWU varies. The fact that a FFWU is dictated in the sign-out suggests it can be prioritized over the cross-covering resident’s clinical impression, a behavior that may not be evidence-based or cost-effective, and is recognized as such by residents. The FFWU culture deserves re-examination.

    Jessica Howard-Anderson, MD1, Kristin Schwab, MD1, Roswell Quinn, MD, PhD2 and Christopher J. Graber, MD, MPH, FIDSA3, (1)Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, (2)Internal Medicine, University of California Los Angeles, Los Angeles, CA, (3)Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA

    Disclosures:

    J. Howard-Anderson, None

    K. Schwab, None

    R. Quinn, None

    C. J. Graber, None

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