539. A Quality Improvement Initiative to Improve the Efficiency of Inpatient Tuberculosis “Rule Outs” in a Community Hospital
Session: Poster Abstract Session: Tuberculosis Epidemiology and Diagnosis
Thursday, October 27, 2016
Room: Poster Hall
  • A Quality Improvement Initiative to Improve the Efficiency of Inpatient Tuberculosis “Rule Outs” in a Community Hospital - ID Week 2016.pdf (1.1 MB)
  • Background: Tuberculosis (TB) remains a public health concern in the USA with 11,000 new cases annually. In order to limit public exposure, hospitalized patients with suspected TB are placed in isolation and require 3 consecutive negative AFB sputum smears to “rule out” active disease before they can be cleared. This process consumes valuable healthcare resources and can prolong the length of hospitalization (LOH) due in part to inefficient sputum collection or processing. Many hospitals have transitioned to every 8 hour sputum AFB collection periods, in accordance with CDC guidelines. However, only changing the collection interval may overlook complexities in the system of AFB processing and as such may not by itself decrease the LOH. At our small community institution (VA in Mather, CA) we did a complete analysis of this process with the goal of minimizing waste and decreasing LOH.

    Methods: Utilizing the Veteran Affairs’ VATAMMCS systems redesign model we analyzed our current process of inpatient tuberculosis “rule outs”. A multidisciplinary team mapped the process for sputum AFB collections, noted inefficiencies, and suggested improvements. In January 2013 a multifaceted intervention which included a new protocol for respiratory therapist guided sputum AFB collections every 12 hours was implemented. A post-intervention and pre-intervention cohort of patients were identified and compared. Medical records were reviewed for basic clinical data and the primary study outcomes: time required for 3 sputum AFB collections, time spent in airborne isolation, and overall LOH.

    Results: During the three-year intervention period (2013-2015) we analyzed 50 separate inpatient encounters, and compared the results with 49 inpatient encounters identified during three years prior to our intervention. Utilizing an independent T-test analysis an improvement in all three primary outcomes was seen and is shown in the table.

    Before Intervention


    After Intervention



    AFB Collection Time (hrs)






    Time in Isolation (days)





    < 0.001

    LOH (days)

    8.0 days





    Conclusion: Our results show that our QI intervention was effective at reducing time spent acquiring sputum samples, maintaining patients in isolation, and length of hospitalization. 

    Kanal Singh, MD1, Raja Jagadeesan, MD1 and Nathan Gundacker, MD2, (1)VA Northern California Healthcare System, Mather, CA, (2)Infectious Disease, University of Alabama at Birmingham, Birmingham, AL


    K. Singh, None

    R. Jagadeesan, None

    N. Gundacker, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.