Innovation in Day to Day Practice: Making PIDS Great Again
Freire Dolores, Real Jhony, Jaramillo Leyda, Espin LuisAbstract
Background
Informal consultations are common in adult and pediatric infectious diseases (ID) practice, the amount of time dedicated to these activities and the value added to patient care has not been systematically measured nor registered in patient’s medical record. We describe an innovative digital registry of day to day informal consultations of the pediatric infectious diseases attending in a pediatric oncologic department.
Methods
From May 2024 to October 2024 a digital registry of daily activities denominated “case review” was designed in Microsoft Power Apps by the Information Management and Productivity department. Approval was granted by the head of the Pediatrics department and the Medical Record Committee so that “non-billed” advice of the pediatric infectious diseases attending will be documented in the patient’s chart. Four categories were created: 1) Antimicrobial optimization, 2) Microbiological studies, 3) Infection control and 4) Follow up. The process involved review of the chart and discussion with the attending physician followed by progress note in the electronic medical record with no bill code associated but labeled as “Pediatric infectious Diseases - Case review”.
Results
A total of 179 recommendations were given in 145 case reviews performed in the 6 month period with an average of 29.8 ± 5.4 suggestions per month. The population of patients consisted in 97 (67%) patients with hematological malignancies, 40(28%) solid tumors and 8(6%) CNS tumors. When considering 103 single recommendations, antibiotic optimization was the most frequent 76 (73%), followed by 18(17%) regarding microbiological studies, 6 (6%) infection control and 3(3%) follow ups. When in combination, the trend remained including antibiotic optimization in additional 37 (49%) combined recommendations. The specialties soliciting advice were pediatric hospitalists 120 (82%), pediatric oncologist 13(9%), pediatric emergency 7 (5%) and pediatric palliative care 5(3%). In addition, during the examined period, 148 patients were seen in clinic and 77 more as inpatient consultations, documenting an increase in 64% of the production of the specialty with the novel “case review”.
Conclusions
Documentation of informal consultations could support the need of dedicated time for specific activities within ID such as optimization of antibiotics. Furthermore, it shows the diversity of the scope of ID in enhancing patient care. Written advice, even when not billed, increases patient safety and invites for discussion and formal consultation when needed.