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Ravneet Singh, M.D. Depinder Mann, M.D.

Ravneet Singh, M.D. Depinder Mann, M.D. Length of Hospital Stay in Patients admitted for Rule Out Tuberculosis at Riverside County Regional Medical Center. Background.

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Ravneet Singh, M.D. Depinder Mann, M.D.

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  1. Ravneet Singh, M.D. Depinder Mann, M.D. Length of Hospital Stay in Patients admitted for Rule Out Tuberculosis at Riverside County Regional Medical Center

  2. Background • Tuberculosis epidemiology varies widely from place to place, however the number of “Rule out Tuberculosis” admissions have shown an increase in California compared to previous years. We have observed the same trends at Riverside County Regional Medical Center. • This increase can be attributed mainly to the increase in immigrant population in California.

  3. Background Rates of Reported TB Cases California and Riverside, 1990–2004 California Cases per 100,000 population Riverside Year

  4. Background Race/Ethnic Composition of Reported TB Cases* and County Population**, Riverside County * Years 2000-2005 **Year 2004 Estimate

  5. Introduction • This study was undertaken to determine the length of hospital stay for patients admitted with “Rule Out Tuberculosis” to RCRMC because we observed an extended utilization of scarce inpatient beds and hospital resources along with increased anxiety to patients and families.

  6. Research Goals • Determine length of stay for patients admitted to RCRMC for “Rule Out Tuberculosis”. • Understand reasons for extended stay. • Recommend protocols and processes to help reduce the extended stay.

  7. Method - Study Design • Retrospective chart review • Consecutive Charts Reviewed: 325 • Review Period: 2003 to 2006 • Inclusion Criteria • Patients over the age of 18 • Primary admitting diagnosis of R/O TB • Exclusion Criteria • Patients under the age of 18 • Secondary diagnosis and co-morbidities • Positive tuberculosis cases • Final number of charts reviewed for the study: 100

  8. Results

  9. Length of Stay

  10. Reasons for Extended Length of Stay

  11. Length of Stay Metrics

  12. Reason #1 for Extended Stay • Inability to collect three consecutive sputum samples for AFB smears and cultures.

  13. Reason #2 for Extended Stay • Incomplete Public Health Form • Incomplete information • No official X-ray readings or no comparison from admission CXR with CXR at time of anticipated discharge • Leads to inability to obtain timely public health clearance

  14. Reason #3 for Extended Stay • Home isolation regulations as provided by Public Health. • Patients unable to adhere to home isolation regulations due to: • Home isolation agreements not signed • Children under the age of 4 years in the home • Early post-partum women • Geriatric family members • Immunocompromised • Includes autoimmune disorders, long-term steroid users

  15. Reason #4 for Extended Stay • Prison facilities delays • Inadequate negative pressure isolation rooms in the prison system. • CIM has only 2 and CRC has only 1 negative isolation pressure rooms.

  16. Limitations of the Study • Retrospective chart review. • Small sample size. • Specific to a county hospital setting.

  17. Conclusion • Majority of the patients spend at least 8 days or more in the hospital. • Extended stay of R/O TB patient caused • Over utilization of hospital resources. • Increased health care costs.

  18. Recommendations • Standardization and implementation of an efficient TB protocol to implement upon admission. • More emphasis on training the nurses and respiratory therapists (RT) for collecting sputum samples for AFB smear and culture tests. • Mandate complete information on public health forms filled by the residents and students. • Coordinate information with Infection Control • Develop skilled nursing facility in Riverside County equipped to handle patients who require a negative pressure isolation room.

  19. Recommended TB Protocol

  20. Future Research • Run a pilot project with the recommended TB protocol on 10 new admissions. • Modify and implement the recommended TB protocol using the findings from the pilot project. • Run the same study again on 100 new admissions and compare the length of hospital stay with current findings.

  21. References • Management of Tuberculosis in the 21st Century, Training Course, Presented by Francis J. Curry National Tuberculosis Center • Diagnostic Standards and Classification of Tuberculosis in Adults and Children, American Thoracic Society (2000) • www.nationaltbcenter.edu • www.cdc.gov

  22. Questions and Answers?

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