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HICprevent

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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Early involvement of an ID doc can be a life saver

January 12th, 2015

In a multivariate analysis using case controls, involvement of an infectious diseases (ID) specialist in the care of patients admitted to an acute care hospital (ACH) resulted in improved outcomes and a lower cost of care -- especially when the ID consultant was involved early in the hospitalization, according to a recent study.

“Patients receiving ID intervention within 2 days of admission had significantly lower 30 day mortality, 30 day readmission, hospital and ICU length of stay, and Medicare charges and payments compared to patients receiving later ID interventions,” the authors concluded.

The impact of ID consultation on important markers, such as length of ICU stay, length of hospital stay, mortality, and frequency of 30-day readmission was assessed for patients admitted to an ACH with at least one of 11 specific infections between January 2008 and November 2009. These common infections were selected based on the ability to query fee-for-service Medicare claims based on DRG code (bacteremia, C. difficile infection, central line-associated bloodstream infection, bacterial endocarditis, HIV, meningitis, osteomyelitis, prosthetic joint infections, septic arthritis, septic shock, and vascular device infections).

A total of 101,991 ACH stays with ID consultation and 170,366 without ID involvement were examined. Patients with ID consultation generally had more than one infection, and were more likely to be male, they were younger, more likely to be admitted to ICU, and were more likely admitted to a teaching hospital compared to those without ID intervention. A matched cohort of more than 120,000 cases was created, and those patients with ID consultation also appeared more likely to have orthopedic infection, were more likely to have had surgery, and were less likely to have respiratory infections compared with the non-ID intervention cohort.

After adjustment for risk factors, cases with ID involvement had statistically significantly lower rates of index stay, lower rates of 30-day mortality, and lower rates of 30-day readmissions. In addition, stays with ID involvement within the first 2 days of hospitalization were associated with a significantly lower 30 day mortality and readmission rate. Furthermore, those cases were associated with a 3.8% reduction in overall hospital stay, 5.1% fewer ICU days, and significantly lower cost of hospital charges, Medicare payments to ACH, and Medicare payments to all providers. These differences were small (on the order of 2.9% to 6.2%) but highly statistically significant.