Increasing evidence-based care practices for patients with Staphylococcus aureus bacteraemia through required infectious diseases consultation in a tertiary care hospital: a quality improvement initiative.

Abstract

Background: Staphylococcus aureus bacteraemia had a higher mortality rate than average at Kingston Health Sciences Centre (KHSC). Infectious diseases specialist consultation has been shown to improve outcomes for S. aureus bacteraemia by increasing adherence to evidence-based care practices. Yet, infectious disease specialists were not involved in many cases at KHSC.

Aim: To improve adherence to evidence-based care practices by increasing the proportion of patients with S. aureus bacteraemia who receive a formal infectious diseases consultation.

Interventions: A multimodal intervention consisting of (1) daily automated email of positive blood culture results to the infectious diseases team; (2) standardisation of prompts attached to positive blood culture results on the electronic medical record; (3) policy of mandatory infectious diseases consultation and (4) education of resident physicians.

Implementation and evaluation: The outcome measure was adherence to evidence-based care practices, defined as echocardiography, repeating blood cultures and treatment with a first-line antibiotic. A secondary outcome measure was 90-day mortality. The process measure was the proportion of patients receiving formal infectious diseases consultation. A balancing measure was hospital length of stay. All measures were monitored semimonthly using statistical process control charts for time periods before and after intervention.

Results: There were 171 and 186 patients with S. aureus bacteraemia in the preintervention and postintervention period, respectively. Between these two periods, the proportion of those who received evidence-based care practices increased from 73% to 82% (p=0.031) and demonstrated special cause variation. Mortality changed from 29% to 24% (p=0.400). The proportion of patients receiving an infectious diseases consultation increased from 47% to 90% (p<0.001) and demonstrated special cause variation. The median (IQR) length of stay was 18 (11-30) days and 17 (11-42) days in the preintervention and postintervention period, respectively (p=0.442).

Conclusions: A multimodal intervention that implemented mandatory infectious diseases consultation significantly improved evidence-based care practices for S. aureus bacteraemia.