Innovative TB risk assessment tool improves patient care and workflow

Innovative TB risk assessment tool improves patient care and workflow

Caitlin Dugdale, MD, MSC and Kimon Zachary, MD, physicians in the Division of Infectious Diseases at Massachusetts General Hospital (MGH) and assistant professors of medicine at Harvard Medical School, are co-lead authors of a new study in Infection Control and Control and Study and Hospital Epidemiology, TB or Not TB? Development and validation of a clinical decision support system for the evaluation of suspected tuberculosis.

Erica Shenoy, MD, PhD, chief of infection control at Mass General Brigham and associate professor of medicine at Harvard Medical School, is senior author of the study.

Patients with suspected tuberculosis (TB) require special precautions in healthcare facilities, and cases of TB have been increasing in the United States. These precautions include isolating people with suspected TB in patient rooms with specialized airspaces known as airborne infection isolation rooms.

To improve our ability to assess patients for potential TB infections, we developed a TB risk assessment tool by reviewing previous patient data. This tool was then integrated into the electronic health record with the label “TB or not TB.”

The tool helps clinicians assess, once their TB work is complete and apparently negative, whether infection control precautions can be discontinued to ensure accurate TB isolation decisions, ease workload and improve patient experience.

The tool has been validated and is now used at all MGB locations.

Background:

Infection prevention and control (IPC) programs are tasked with implementing appropriate isolation of patients with suspected or confirmed communicable diseases to reduce the risk of infections in healthcare settings and reduce occupational risk to healthcare workers.

However, isolating patients can negatively impact clinical workflows, access to care, and hospital capacity, highlighting the critical importance of safe and efficient entolation protocols. Systems-based solutions for isolation and deide, including clinical decision support tools, are increasingly needed to:

• Unterstützen Sie die Sicherheit des Patienten und des Gesundheitswesens
• Reduzieren Sie die kognitive und administrative Belastung für Kliniker
• Verbesserung des Wohlbefindens des Klinikers

A team of infection prevention experts, physicians and researchers at Massachusetts General Hospital (MGH) developed a risk assessment tool by reviewing the records of previous patients diagnosed with TB. They created a validated model to assess the likelihood of TB infection before isolation precautions were discontinued.

Then the same team collaborated with clinical informatics and digital health developers to program the scoring model into the electronic health record in the form of a tool called “TB or not TB.”

When a patient is identified as having an evaluation for TB, they are designated as “TB risk,” which leads to proper isolation in the dedicated hospital room and use of personal protective equipment. Once the healthcare provider believes that TB is no longer a possibility given the patient's symptoms, test results and/or risk factors, they may use the TB or non-TB tool to determine whether it is safe to discontinue isolation precautions.

What are the clinical implications and next steps?

This tool has a positive impact on patient care and physicians. In a rigorous analysis of TB assessments across the MGB system over six years, the tool correctly identified all cases where TB infections were present and ensured that all of these patients would remain safely isolated during their work.

At the same time, the tool was able to identify about a quarter of cases where TB was highly unlikely. This enables the tool to allow these patients to emerge from isolation safely and efficiently, which can increase bed capacity, ease workload, reduce time for infection control consultations and improve patient experience.

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