Diagnosis and treatment of pulmonary tuberculosis in hospitalized patients are affected by physician specialty and experience.
BACKGROUND
Healthcare system delays in the diagnosis of tuberculosis can increase the risk of its nosocomial transmission. We aimed to determine whether different physicians' specialties and experience influenced this diagnostic delay.


METHODS
We retrospectively reviewed the cases of 167 patients with smear-positive pulmonary tuberculosis who were hospitalized from September, 2004, to August, 2006, for 5 components of healthcare system delays according to the World Health Organization definitions and analyzed the impact of physicians' specialties and their experience (annual number of patients treated for tuberculosis) on these delays.


RESULTS
The median suspicion delay was significantly longer for patients in surgical departments than those in medical departments (4 days versus 1 day, P = 0.001) and for patients treated by nontuberculosis specialists than those treated by tuberculosis specialists (including pulmonologists, infectious diseases specialists and thoracic surgeons; 3 days versus 1 day, P < 0.001). Both were independent factors related to suspicion delay examined by multivariate analysis. The annual number of tuberculosis patients in each department had a significant negative correlation with suspicion delay (r = -0.303, P < 0.001).


CONCLUSIONS
Patients treated by surgeons and nontuberculosis specialists who were inexperienced in treating tuberculosis experienced a longer suspicion delay. Enhancing knowledge about tuberculosis among all physicians in the hospital, encouraging staff to consult tuberculosis specialists to confirm a diagnosis and implementing early alarm systems are crucial to improving the correct diagnosis of tuberculosis and to reducing delays in treatment.
Chen
Tun-Chieh
TC
Infection Control Room and Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
Lu
Po-Liang
PL
Lin
Wei-Ru
WR
Lin
Chun-Yu
CY
Lin
Shu-Hui
SH
Lin
Chuen-Ju
CJ
Lo
Wan-Ching
WC
Chen
Yen-Hsu
YH
D000368:Aged; D003428:Cross Infection; D003695:Delivery of Health Care / Q000592:standards; D004501:Education, Medical; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008511:Medicine; D008875:Middle Aged; D010820:Physicians / Q000592:standards; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000628:therapy*; D000078329:Workforce