Background: Care transitions, such as hospital discharge, have inherent patient safety vulnerabilities. Inpatient microbiological results present particular challenges, as cultures have variable incubation periods and results may finalize after discharge. Failure of timely review and subsequent appropriate management based on final results has led to negative clinical consequences in our facility. Our quality improvement (QI) aim was to have 100% of cultures pending at the time of patient discharge reviewed and acted on within 72 hours of a final result.
Methods: A multidisciplinary QI team including members of the antibiotics stewardship, conducted multiple plan-do-study-act (PDSA) cycles starting with a daily computer-generated comprehensive report listing the cultures finalized within the preceding 24 hours for recently discharged patients. For results that were clinically significant, the team determined if the discharging team had already taken the appropriate action. If the results had either not yet been reviewed by the discharging team, or if the patient had not been prescribed appropriate antimicrobial therapy at discharge, the team contacted the discharging team with recommendations. We measured outcomes using statistical control methods to assess trends over time.
Results: We reviewed 752 cultures obtained from hospitalized patients discharged between June 2015 and April 2016. 183 cultures were collected prior to the start of the interventions; only 87% of the clinically significant results were reviewed in less than 72 hours after finalization. The percentage of final results reviewed within 72 hours increased to 100% after the second intervention in September 2015. After implementation of the safety system, the QI team initiated clinical management changes in 3.5% of the results reviewed.
Figure: P Chart of Percentage of by Week of Post Discharge Cultures’ Results Reviewed in Less than 72 Hours.
Conclusion: The establishment of a hospital-wide safety system for systematic follow up of microbiological cultures pending at discharge improved timely follow up of results. Other health systems can replicate this system to achieve similar rates of compliance, moreover embedding this work in existing antibiotic stewardship efforts is a win-win for patient safety.
B. Barns, None
K. Homa, None
D. Beaulieu, None
A. Holmes, None
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