A Multi-Disciplinary Initiative to Streamline and Expedite the Pulmonary Tuberculosis Rule Out Process

BACKGROUND Multi-factorial problems were encountered in ruling patients out for Tuberculosis in a healthcare facility located in one of the highest incidence areas in the United States. These problems led to increased time spent in Airborne Isolation as well as extended in-patient stays. The objective of the team was to streamline the process through education, protocol change, increased communication and collaboration, and real-time resolution of barriers. Other objectives included decreasing sputum collection time to under 20?hours and to decrease the length of time spent in negative airflow by 20%. METHODS A Task Force was convened to review the challenges of efficiently ruling out patients with risk factors for Tuberculosis. The Tuberculosis log was reviewed for 3 months to determine the duration of time spent in Airborne Isolation rooms and how long it took for the completion of specimen collection. The group developed/implemented a combination of structured/unstructured education, protocol changes, creating a physician order-set, standard work and real-time fixes to reinforce practice change. Charting of sputum collection time and discontinuation of Airborne Isolation in the electronic medical record was utilized to determine percentage of change. RESULTS Results indicated that there was an improvement in the rule out process over a 15-month period, and increased timely discontinuation of Airborne Isolation. Results demonstrated an increase from 31.17% to 70% in the completion of specimen collection under 20?hours. The average number of days spent in Airborne Isolation decreased from 3.09?days to 2.35 days(24%). CONCLUSIONS The study found that a combination of education, protocol change, increased communication and collaboration, as well as real-time resolution of barriers streamlined the rule out process, improved patient throughput and efficiency. While the authors did not measure patient or staff satisfaction, it must be noted that there were less complaints by the health care team and patients.