Evaluating the effectiveness of a screening tool to decrease the number of non-isolated hours in patients with identified Tuberculosis risk factors in an acute care facility

Abstract

ISSUE: Failure to identify patients with risk factors related to Tuberculosis (TB) in a timely fashion has led to multiple exposures of healthcare workers in our facility to TB. We recognized that early identification of at-risk patients should start in our emergency room (ER). During the pos- SARS period, we were at a heightened awareness of patients presenting with respiratory symptoms. We already had a screening tool in place post-SARS to help identify SARS risk factors for all patients being admitted to the facility and we decided that adding TB risk factors to the screening tool could potentially improve early identification of possible TB patients. PROJECT: Data were collected to determine the length of time admitted patients at high risk for TB were in our facility before being placed in appropriate isolation precautions. These data were gathered for the 6-month period prior to the introduction of the new screening tool and for the 6-month period following its implementation. Nurses in the ER were trained in the completion of the form and educated regarding the purpose of the addition to the existing screening tool. The number of non-isolated hours of high-risk patients and therefore potential TB exposure to healthcare workers was compared from the period before introduction of the screening tool to the period after. RESULTS: Comparison of data from the pre- and post-intervention periods did not reveal a significant difference in the non-isolated hours of at-risk patients. Prior to the change to the screening tool, the average number of non-isolated hours was 15.45 hours per high risk patient, compared to 13.775 hours after the change to the screening tool. An incidental finding was that in the 6-month period following the change to the screening tool, there was a twofold increase in the number of patients identified on admission as being at risk for TB and placed in appropriate isolation. Instead of isolating four possible TB patients for each one positive, the number increased to eight to one. LESSONS LEARNED: While we were able to improve our early identification of high-risk patients on the admission screening form, the majority of the non-isolated hours occurred in the ER prior to the patient being admitted as an inpatient. While we have improved early identification of admitted patients with TB risk factors, our next step s to implement the screening tool at triage in order to decrease non-isolated hours prior to admission.