Management of Isolation Precautions in Ambulatory Care Settings

Abstract

<h3>Background</h3> Failure to discontinue transmission-based precautions (TBP) for eligible ambulatory patients may decrease stakeholder buy-in, adherence, and experience. Successful removal is hindered by unclear criteria and inadequate resources. We sought to create a pre-visit review process to identify TBP removal opportunities to support stakeholders without exhausting resources. <h3>Methods</h3> Study period was 11/02/2020 – 11/30/2021. We generated an electronic medical record (EMR) report of ambulatory encounters in the coming week with a TBP flag. Interventions tested included: A spreadsheet macro to filter and format the EMR report (implemented 01/29/21); Standardized IP chart review and notification; Clinical stakeholder engagement to define and evaluate process expectations. We used a standard t-test for weekly encounter and percent no-change review comparisons. <h3>Results</h3> During 11/02/2020-01/28/21, 3,111 encounters were reviewed for TBP removal. Of those, 310(9.96%) had TBP status updated, 1,134(36.45%) required email communication to determine status, and 1,667(53.58%) had no change. These no-change encounters included cystic fibrosis patients (remain in life-long TBP) and ineligible long term TBP. We built the macro to remove no-change encounters to focus on encounters needing review. During 1/29/21-11/27/21, 6,060 encounters were reviewed, with 1,818(30.00%) updated, 1,646(27.16%) requiring email, and 2,596(42.84%) no-change. Macro implementation reduced average reviewed encounters weekly (246 to 142, p<.0001) and the proportion of no-change encounters (56.36% to 47.39%, p=0.0224). Subjectively, reviews took less time (approximately 15 hours to 5 hours per week). Process standardization and stakeholder engagement were well-received. <h3>Conclusions</h3> Macro utilization increased review efficiency by removing no-change encounters. Despite a reduction in pre- and post-implementation proportions of no-change encounters, there is still opportunity to further reduce time wasted on no-change encounters. Standardizing our process allowed for cross training of IPs, alleviating burden on others. Stakeholder engagement improved relationships between IPs and ambulatory staff.