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In healthcare settings, patients suspected of having tuberculosis (TB) necessitate specific precautions, especially as the incidence of TB has seen an upward trend in the United States in recent years. Among these precautions is the need to isolate such patients in designated rooms with specialized airborne infection isolation systems.
To enhance the process of evaluating patients for potential TB infections, a new TB risk scoring tool has been created based on an analysis of historical patient information. This tool, which is now part of the electronic health record, is referred to as “TB or Not TB.”
The primary function of this tool is to assist clinicians in determining if infection control measures can be safely lifted once a TB workup is concluded and returns negative. Its implementation is designed not only to support accurate decisions regarding TB isolation protocols but also to alleviate the workload on healthcare providers and improve overall patient experiences.
This TB risk scoring tool has been validated and is currently operational across all Massachusetts General Brigham (MGB) healthcare sites.
Background:
The Infection Prevention and Control (IPC) programs are responsible for ensuring the correct isolation of patients with suspected or confirmed communicable diseases. This is crucial in minimizing risks of healthcare-associated infections among patients and protecting healthcare workers from occupational hazards.
However, isolating patients can disrupt clinical workflows and hinder access to care, thus emphasizing the need for safe and effective protocols for both isolation and subsequent deisolation. There is a growing demand for systematic solutions that enhance safety for both patients and healthcare staff, alleviating the cognitive and administrative burdens on clinicians, while also promoting their well-being.
A collaborative team at Massachusetts General Hospital, comprising experts in infection prevention, infectious disease physicians, and researchers, undertook the task of developing the TB risk scoring tool. This involved examining past patient records to differentiate between those diagnosed with TB and those who were at risk but not infected. Through this analysis, they established a validated model to evaluate the probability of TB infection, which assists in making informed decisions about ending isolation precautions.
The team worked alongside digital health developers to incorporate this scoring model into the electronic health records in the form of the “TB or Not TB” tool.
When a patient is flagged as requiring TB evaluation, they receive a “TB-Risk” designation, triggering appropriate isolation protocols and usage of personal protective equipment. Upon a healthcare provider’s assessment—based on the patient’s symptoms, test results, and other risk factors—that TB is no longer suspected, they can utilize the tool to assess whether it is safe to lift isolation precautions.
What are the Clinical Implications and Next Steps?
The introduction of this tool is set to enhance both patient care and clinician workflows significantly. A comprehensive review of TB evaluations conducted within the MGB system over six years has shown that the tool accurately detected all cases where TB infection was confirmed, ensuring these patients remained safely isolated during their assessment process.
Furthermore, the tool effectively identified approximately 25% of cases where TB was assessed to be highly unlikely. This functionality permits those patients to be released from isolation promptly and safely, potentially increasing hospital bed availability, decreasing clinician workload, reducing the duration of infection control consultations, and enhancing the patient care experience overall.
Source
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