Contribution of infectious disease consultation toward the care of inpatients being considered for community-based parenteral anti-infective therapy.
BACKGROUND
In the acute care setting in a multidisciplinary healthcare environment, the contribution of infectious disease (ID) specialists to overall patient care is difficult to measure. This study attempts to quantify the contribution of ID specialists when consulted for an activity specific to ID practice, community-based parenteral anti-infective therapy (CoPAT).


METHODS
In February 2010, an electronic form for requesting ID consultations was introduced in the computerized provider order entry (CPOE) system at the Cleveland Clinic. This allowed for easy identification of ID consultations for CoPAT. Hospital records for all patients with CoPAT consultation requests between February 11, 2010 and May 15, 2010 were reviewed for specific defined contributions in the domains of optimization of antimicrobial therapy, significant change in patient assessment, and additional medical care contribution.


RESULTS
Over a 3-month period, there were 263 CoPAT consultation requests via CPOE, of which 172 were initial consultations and 91 reconsultations. Antimicrobial treatment was optimized in 84%, a significant change in patient assessment made in 52%, and additional medical care contribution provided in 71% of consultations. In 33% of consultations, there was contribution in all 3 domains. CoPAT was deemed not to be necessary in 27%. For patients requiring CoPAT, effective care transition from the inpatient to outpatient setting was assured at least 86% of the time.


CONCLUSIONS
Infectious disease consultation before discharge on parenteral antibiotics adds value by contributing substantially to inpatient care, and providing antimicrobial stewardship and continuity of care at a critical patient care transition point.
Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. shrestn@ccf.org
Nabin K
NK
Shrestha
Archana
A
Bhaskaran
Nikole M
NM
Scalera
Steven K
SK
Schmitt
Susan J
SJ
Rehm
Steven M
SM
Gordon
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000639:trends*; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D003141:Communicable Diseases / Q000175:diagnosis / Q000188:drug therapy*; D003151:Community Health Centers / Q000639:trends; D003266:Continuity of Patient Care / Q000639:trends; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007263:Infusions, Parenteral / Q000379:methods / Q000639:trends*; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000379:methods / Q000639:trends; D012017:Referral and Consultation / Q000639:trends*
D000890:Anti-Infective Agents