Outcomes Associated with Implementation of an Electronic Health Record Based Automatic Infectious Disease Consultation for Positive Blood Cultures with Staphylococcus aureus
Authors: Taylor Bird, Elise Richoux, Brandon Hawkins, Samantha Walker, Miller Hadley, Amber Wolfe
Background: Staphylococcus aureus bacteremia is often associated with high rates of morbidity and mortality if not managed appropriately. Infectious Diseases (ID) involvement in the clinical care of these patients has demonstrated reduced mortality, with early ID consultation also associated with decreased hospital length of stay. This study aims to evaluate the impact of an automatic electronic-health record (EHR) based ID consultation for patients with S. aureus bacteremia. This study will assess whether the automatic ID consultation protocol improves hospital length of stay, time to ID consultation, and time to targeted therapy.
Methods: This single-center, retrospective, observational cohort study evaluated the impact of an EHR based automatic infectious disease consultation order for patients with S. aureus bacteremia. This protocol was implemented July 1, 2024. The pre-intervention group was composed of hospital encounters from June 1, 2022 through May 31, 2024, while the post-intervention group contained hospital encounters from July 1, 2024 through April 30, 2025. The primary outcome evaluated overall hospital length of stay. Secondary outcomes included time to ID consultation, time to targeted therapy, and pharmacist interventions recommending ID consultation. Potential subjects were identified via a list generated from clinical surveillance software (TheraDoc). List composition components included patients with at least one positive blood culture for S. aureus. Patients were included in the study, if they were 18 years of age or older and received an ID consultation during the related hospitalization. Exclusion criteria included death or transition to hospice within 48 hours of a positive culture result, patient directed discharge prior to clinical stability, or consult communication to the ID service greater than 24 hours after the EHR automatically ordered an ID consult. Statistical analysis will be performed using SPSS (IBM). Categorical data will be analyzed using Chi-Square or Fisher’s Exact tests. Continuous data will be analyzed using Student’s t-test or Mann-Whitney U test, as appropriate.
Results: Hospital length of stay was significantly shorter in the post-intervention groups as compared to the pre-intervention group (15.3 vs 19.1 days p = 0.01). Time to ID consultation was not significantly different, with a mean of 0.38 ± 1.35 days in the pre-intervention group compared to 0.52 ± 0.48 days in the post-intervention groups (p = 0.226). Time to targeted antibiotic therapy was significantly shorter in the post-intervention group with a mean of 2.40 days compared to 2.90 days in the pre-intervention group (p = 0.039). Pharmacy interventions recommending ID consultation were significantly lower in the post-intervention group (5.7% vs 0%; p = 0.001).
Conclusions: The implementation of an electronic health record based automatic infectious disease consultation protocol for Staphylococcus aureus bacteremia resulted in significant reductions in overall hospital length of stay and decreased the time to targeted antibiotic therapy.
