Increasing evidence-based care practices for patients with Staphylococcus aureus bacteraemia through required infectious diseases consultation in a tertiary care hospital: A quality improvement initiative

Abstract

Background Staphylococcus aureus bacteraemia had a higher mortality rate than average at Kingston Health Sciences Centre (KHSC). Infectious diseases specialist consultation has been shown to improve outcomes for S. aureus bacteraemia by increasing adherence to evidence-based care practices. Yet, infectious disease specialists were not involved in many cases at KHSC. Aim To improve adherence to evidence-based care practices by increasing the proportion of patients with S. aureus bacteraemia who receive a formal infectious diseases consultation. Interventions A multimodal intervention consisting of (1) daily automated email of positive blood culture results to the infectious diseases team; (2) standardisation of prompts attached to positive blood culture results on the electronic medical record; (3) policy of mandatory infectious diseases consultation and (4) education of resident physicians. Implementation and evaluation The outcome measure was adherence to evidence-based care practices, defined as echocardiography, repeating blood cultures and treatment with a first-line antibiotic. A secondary outcome measure was 90-day mortality. The process measure was the proportion of patients receiving formal infectious diseases consultation. A balancing measure was hospital length of stay. All measures were monitored semimonthly using statistical process control charts for time periods before and after intervention. Results There were 171 and 186 patients with S. aureus bacteraemia in the preintervention and postintervention period, respectively. Between these two periods, the proportion of those who received evidence-based care practices increased from 73% to 82% (p=0.031) and demonstrated special cause variation. Mortality changed from 29% to 24% (p=0.400). The proportion of patients receiving an infectious diseases consultation increased from 47% to 90% (p<0.001) and demonstrated special cause variation. The median (IQR) length of stay was 18 (11-30) days and 17 (11-42) days in the preintervention and postintervention period, respectively (p=0.442). Conclusions A multimodal intervention that implemented mandatory infectious diseases consultation significantly improved evidence-based care practices for S. aureus bacteraemia.