Evaluation of an infectious disease consultation programme in a German tertiary care hospital

• Published in: Infection 2013-12, Vol.41 (6), p.1121-1128
• Main Authors: Vehreschild, J. J., Morgen, G., Cornely, O. A., Hartmann, P., Koch, S., Kalka-Moll, W., Wyen, C., Vehreschild, M. J. G. T., Lehmann, C., Gillor, D., Seifert, H., Kremer, G., Fätkenheuer, G., Jung, N.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents - therapeutic use; Child; Child, Preschool; Clinical and Epidemiological Study; Communicable Diseases - diagnosis; Communicable Diseases - drug therapy; Family Medicine; Female; General Practice; Germany; Guideline Adherence; Hospital Departments - standards; Humans; Infant; Infectious Diseases; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Referral and Consultation - standards; Statistical analysis; Tertiary Healthcare; Treatment Outcome; Young Adult
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-013-0512-1

Purpose To evaluate a newly implemented infectious disease (ID) consultation service in terms of patient care, outcome and antibiotic prescription and to describe factors influencing adherence to recommendations. Methods Data from consultations during the first 6 months of the ID consultation program were collected and evaluated. Consultation requests, diagnostic results, treatment outcomes and antibiotic recommendations were categorised. Diagnostic and therapeutic recommendations were assessed and rated for adherence and outcome. Statistical analysis was performed to identify factors influencing adherence and treatment outcome. Results A total of 251 consultations were assessed. In most cases, ID specialists were asked for further advice regarding a previously initiated anti-infective treatment ( N  = 131, 52 %). In 54 of 195 (28 %) first consultations, the ID specialist proposed a differential diagnosis that differed from that of the working diagnoses submitted with the consultation request, and which was subsequently confirmed in 80 % of these cases. Diagnostic and therapeutic recommendations were made in 190 (76 %) and 240 (96 %) of the consultations, respectively. A change in the current treatment was recommended in 66 % of consultations; 37 % of recommendations were cost-saving and 26 % were cost-neutral. Compliance with diagnostic and therapeutic recommendations was rated as good by pre-specified criteria in 65 and 86 % of consultations, respectively. Treatment outcome was correlated with adherence to diagnostic recommendations ( P  = 0.012). Twenty-nine patients (16 %) died during the same hospital stay. Conclusion Infectious disease consultations may help to establish the correct diagnosis, resulting in the appropriate treatment being provided to a severely sick patient population. Treatment outcome was improved in cases of good diagnostic adherence to the recommendations of the ID specialist.