Utilizing an EMR to Increase Infectious Disease Consultations

Staphylococcus aureus bacteremia (SAB) can be challenging to treat as these infections can often have poor outcomes and can be reoccurring. It also can have a higher mortality rate compared with other bactermia caused by pathogens.

A small study found using comments within an EMR led to greater utilization of infectious disease (ID) provider consultations.

The findings were presented at the 23rd Annual Making a Difference in Infectious Disease Meeting 2021 virtual sessions.

The investigators did a retrospective study where they reviewed Theradoc EMR for all inpatients 18 years and older who present with SAB during 2 timeframes: one year prior to the EMR comment implementation (4/1/2018-04/30/2019; Group 1) and one year after EMR comment implementation (11/1/2019-11/30/2020; Group 2).

Medical providers were given a 6 month integration period to use the EMR comment feature. For the purposes of the study, patients who had more than one positive Staph aureus blood culture during the same admission were included as one data point, but all subsequent positive blood cultures during the same admission were excluded. In addition, patients who already had an infectious disease consultation prior to SAB infection were excluded.

"The percentage of patients who had an ID consult during the admission was calculated for each group,” the investigators explained. “The time from the blood culture report indicating Staph aureus was growing to the time an ID consult was ordered was measured in median hours (interquartile ranges, IQR) for each group and compared using the Wilcoxon rank sum test.”

In terms of results, “11/89 (12.4%) of patients in pre-intervention Group 1 did not have an ID consult placed during their admission as compared to 5/92 (5.5%) of patients in post-intervention Group 2. When evaluating time to ID consult between the two groups, Group 1 (prior to comment) had a median of 24.43 hours [3.75-44.05] to ID consult while Group 2 (post comment) had a median of 5.05 hours [1.28-23.45] to ID consultation (p=0.0001),” the investigators wrote.

In thinking about this relatively simple technology to employ, EMR comment features are one way to improve upon the patient experience, and offer the clinical care team a diagnostic communication tool to enable needed consults. These follow-up interactions could also lead to better outcomes and lessen time to recovery.

“Implementation of an EMR comment added to all blood cultures positive for Staph aureus indicating ID consultation for Staph aureus bacteremia improves patient outcomes and reduces length of stay, can effectively alter medical provider practices by increasing percentage of ID consults placed overall as well a statistically significant decrease in time to ID consultation,” the investigators wrote.