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Letters to the Editor
Modern technology and infectious diseases activity data: how can we use this for service planning? We read with interest the article by Bursle et al.1 describing the infectious diseases (ID) experience at a tertiary hospital with a 25-bed intensive care unit (ICU). Our institution is a 975-bed tertiary hospital with 38 ICU beds, trauma, organ transplant and high-risk haemopoietic stem cell transplant services. We recently conducted an audit of our workload using a customdesigned iPad database from February to August 2014. Although Bursle et al. and Ingram et al. have reported new consultation rates of 10 and 11.5 per week, respectively,1,2 our number of formal consultations per trainee was higher (median 31, interquartile range 26–36). The number of consults per occupied bed days (OBD) was similar to Bursle et al., thus our rate is due to higher patient numbers.1 At our institution, 30% of referrals come from the ICU or haematology service (19/1000 OBD), contrasting 8.6– 10% and 11/1000 OBD reported in other Australian institutions.1,2 Since all provide proactive ID consultative ward rounds, there must be an alternative explanation for the higher rate in our centre. Formal ID consultations are associated with improved patient outcomes compared to informal advice,3,4 and in a quaternary centre with a large number of high-acuity patients this must be considered in service planning. Current diagnosis-related group-based funding models are based on inpatient admissions. In our unit, admissions have increased by 17% over 2013–2014. However, we found that 70% of formal inpatient interactions were consultations. Thus, our funding accounts for up to 30% of the department workload in a direct patient interaction. Neither Bursle et al. or Ingram et al. assessed the
References 1 Bursle EC, Playford EG, Looke DFM. Infectious diseases consultations at an Australian tertiary hospital: a review of 11 511 inpatient consultations. Intern Med J 2014; 44: 998–1004. 2 Ingram PR, Cheng AC, Murray RJ, Blyth CC, Walls T, Fisher DA et al. What do infectious diseases physicians do? A 2-week snapshot of inpatient consultative activities across Australia, New Zealand
contribution of informal advice to workload.1,2 We also evaluated data for all consulting registrar interactions; 30% of these involved informal telephone advice. We recently implemented the use of a mobile telephone to facilitate data collection and analysis of the time spent on the calls. The time spent on formal and informal consultative work is important to inform funding models. This analysis of our departmental activities has led to structural change. We have introduced an antimicrobial stewardship (AMS) team that has been shown to streamline consultative work and improve patient care.5 AMS and ID consultation at the time of patient admission has the capacity to enhance this effect over and above a more reactive intervention after 24–72 h,6 and would require increases in staffing. The use of electronic devices to document accurately the departmental workload has facilitated strategic planning. Data could also be used for quality activities such as clinical audits, and as a basis to request extra funding where necessary. Received 21 December 2014; accepted 31 March 2015. doi:10.1111/imj.12772 1,2
2,3
C. Keighley, P. Hamor, S. Chen,1,4 M. R. Watts,1 M. W. Douglas,1,5,6,7 J. Kok,1,4,5 M. O’Sullivan,1,4,5 D. H. Mitchell,1,4 D. Packham,1,2 T. C. Sorrell1,2,5,6 and J. R. Iredell1,4,5,6 1 Centre for Infectious Diseases and Microbiology and 4Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR – Pathology West, Westmead Hospital, 2Department of Medicine and 5 Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, 3Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, 6Westmead Millennium Institute and 7Storr Liver Centre, Westmead Millennium Institute, University of Sydney at Westmead Hospital, Sydney, New South Wales, Australia
and Singapore. Clin Microbiol Infect 2014; 20: O737–44. 3 Forsblom E, Ruotsalainen E, Ollgren J, Järvinen A. Telephone consultation cannot replace bedside infectious disease consultation in the management of Staphylococcus aureus bacteremia. Clin Infect Dis 2013; 56: 527–35. 4 Schmitt S, McQuillen DP, Nahass R, Martinelli L, Rubin M, Schwebke K et al. Infectious diseases specialty intervention is associated with decreased mortality and
lower healthcare costs. Clin Infect Diseas 2014; 58: 22–8. 5 Australian Commission on Safety and Quality in Healthcare. Antimicrobial Stewardship. 2011; 17: 1–240. 6 Borde J, Kern W, Hug M, Steib-Bauert M, de With K, Busch HJ et al. Implementation of an intensified antibiotic stewardship programme targeting third-generation cephalosporin and fluoroquinolone use in an emergency medicine department. Emerg Med J 2014. doi:10.1136/emermed-2014-204067
© 2015 Royal Australasian College of Physicians
688
Letters to the Editor
Modern technology and infectious diseases activity data: how can we use this for service planning? We read with interest the article by Bursle et al.1 describing the infectious diseases (ID) experience at a tertiary hospital with a 25-bed intensive care unit (ICU). Our institution is a 975-bed tertiary hospital with 38 ICU beds, trauma, organ transplant and high-risk haemopoietic stem cell transplant services. We recently conducted an audit of our workload using a customdesigned iPad database from February to August 2014. Although Bursle et al. and Ingram et al. have reported new consultation rates of 10 and 11.5 per week, respectively,1,2 our number of formal consultations per trainee was higher (median 31, interquartile range 26–36). The number of consults per occupied bed days (OBD) was similar to Bursle et al., thus our rate is due to higher patient numbers.1 At our institution, 30% of referrals come from the ICU or haematology service (19/1000 OBD), contrasting 8.6– 10% and 11/1000 OBD reported in other Australian institutions.1,2 Since all provide proactive ID consultative ward rounds, there must be an alternative explanation for the higher rate in our centre. Formal ID consultations are associated with improved patient outcomes compared to informal advice,3,4 and in a quaternary centre with a large number of high-acuity patients this must be considered in service planning. Current diagnosis-related group-based funding models are based on inpatient admissions. In our unit, admissions have increased by 17% over 2013–2014. However, we found that 70% of formal inpatient interactions were consultations. Thus, our funding accounts for up to 30% of the department workload in a direct patient interaction. Neither Bursle et al. or Ingram et al. assessed the
References 1 Bursle EC, Playford EG, Looke DFM. Infectious diseases consultations at an Australian tertiary hospital: a review of 11 511 inpatient consultations. Intern Med J 2014; 44: 998–1004. 2 Ingram PR, Cheng AC, Murray RJ, Blyth CC, Walls T, Fisher DA et al. What do infectious diseases physicians do? A 2-week snapshot of inpatient consultative activities across Australia, New Zealand
contribution of informal advice to workload.1,2 We also evaluated data for all consulting registrar interactions; 30% of these involved informal telephone advice. We recently implemented the use of a mobile telephone to facilitate data collection and analysis of the time spent on the calls. The time spent on formal and informal consultative work is important to inform funding models. This analysis of our departmental activities has led to structural change. We have introduced an antimicrobial stewardship (AMS) team that has been shown to streamline consultative work and improve patient care.5 AMS and ID consultation at the time of patient admission has the capacity to enhance this effect over and above a more reactive intervention after 24–72 h,6 and would require increases in staffing. The use of electronic devices to document accurately the departmental workload has facilitated strategic planning. Data could also be used for quality activities such as clinical audits, and as a basis to request extra funding where necessary. Received 21 December 2014; accepted 31 March 2015. doi:10.1111/imj.12772 1,2
2,3
C. Keighley, P. Hamor, S. Chen,1,4 M. R. Watts,1 M. W. Douglas,1,5,6,7 J. Kok,1,4,5 M. O’Sullivan,1,4,5 D. H. Mitchell,1,4 D. Packham,1,2 T. C. Sorrell1,2,5,6 and J. R. Iredell1,4,5,6 1 Centre for Infectious Diseases and Microbiology and 4Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR – Pathology West, Westmead Hospital, 2Department of Medicine and 5 Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, 3Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, 6Westmead Millennium Institute and 7Storr Liver Centre, Westmead Millennium Institute, University of Sydney at Westmead Hospital, Sydney, New South Wales, Australia
and Singapore. Clin Microbiol Infect 2014; 20: O737–44. 3 Forsblom E, Ruotsalainen E, Ollgren J, Järvinen A. Telephone consultation cannot replace bedside infectious disease consultation in the management of Staphylococcus aureus bacteremia. Clin Infect Dis 2013; 56: 527–35. 4 Schmitt S, McQuillen DP, Nahass R, Martinelli L, Rubin M, Schwebke K et al. Infectious diseases specialty intervention is associated with decreased mortality and
lower healthcare costs. Clin Infect Diseas 2014; 58: 22–8. 5 Australian Commission on Safety and Quality in Healthcare. Antimicrobial Stewardship. 2011; 17: 1–240. 6 Borde J, Kern W, Hug M, Steib-Bauert M, de With K, Busch HJ et al. Implementation of an intensified antibiotic stewardship programme targeting third-generation cephalosporin and fluoroquinolone use in an emergency medicine department. Emerg Med J 2014. doi:10.1136/emermed-2014-204067
© 2015 Royal Australasian College of Physicians
688
