Tuberculosis (TB) is a growing concern in the United States, as evidenced by rising cases over the years. This substantial health risk necessitates stringent precautions in healthcare settings, including the use of specialized airborne infection isolation rooms for patients suspected to have TB.
Recognizing the need for a more proactive and systematic approach, a team of experts from Massachusetts General Hospital (MGH) in collaboration with clinical informatics and digital health developers, crafted a TB risk scoring tool. Named ‘TB or Not TB’, this tool is encoded into the electronic health record and functions by aiding clinicians to evaluate the potential TB status of patients based on historical patient data.
After completion of the TB workup and presuming negative results, the tool helps decide whether the infection control precautions can be discontinued, ensuring accurate decision-making for TB isolation, lessening the workload, and enhancing patient experience. This tool is now implemented across all sites of Massachusetts General Brigham (MGB).
Infection Prevention and Control (IPC) programs bear the responsibility of implementing proper isolation procedures for patients with suspected or verified communicable diseases. This is done to curtail the risk of healthcare-associated infections for patients and limit occupational dangers to healthcare staff. Nonetheless, patient isolation can disrupt clinical workflows, impede access to care, and strain hospital capacity, emphasizing the critical need for secure and efficient deisolation protocols. Hence, system-based solutions, inclusive of clinical decision support tools like ‘TB or Not TB’, are becoming imperative.
When a patient requires evaluation for TB, they are characterized as ‘TB-Risk’, leading to correct isolation in specialized hospital rooms and utilization of appropriate personal protective equipment. If TB is ruled out as a possibility based on symptoms, test results, and/or risk factors, the ‘TB or Not TB’ tool can be employed to establish if isolation precautions can be safely discontinued.
In a comprehensive analysis of six years’ worth of TB evaluations across the MGB system, the tool accurately identified all instances where TB infection was present, ensuring those patients were safely isolated. Simultaneously, the tool identified approximately 25% of cases where TB was highly improbable, allowing those patients to be safely and efficiently deisolated. This improved bed capacity, reduced workload, cut down infection control consultations time, and enhanced patient experience.
This innovative approach encapsulated in the ‘TB or Not TB’ tool demonstrates the potential of healthcare technology in managing infectious diseases. It contributes positively to patient care, clinician workflows, and the overall efficiency of healthcare facilities.