Program Evaluation: Clinical Decision Support and Hospital Laboratory Utilization in the

Detection of Active Tuberculosis Disease

Kate Wukasch Kollman, MSN, APRN, ANP-BC 

Dr. Amy Shay, Ph.D., RN, APRN-CNS, FCNSU

DJ Shannon, MPH, CIC

Background/statement of problem/objectives of the analysis

Evidence-based laboratory testing is an important, yet sometimes incomplete, step in the diagnosis of active pulmonary tuberculosis (TB) disease. Tuberculosis controllers in a Midwestern United States metropolitan health department reported a gap in testing at healthcare facilities throughout the region. An electronic clinical decision support (CDS) tool was created at a partnering hospital aimed at improving active pulmonary TB disease testing.

This project examined the effects of the CDS change on the initial laboratory testing ordered for patients who were eventually diagnosed with active pulmonary TB at one facility.  The tests of interest were acid-fast bacilli (AFB), culture, and nucleic acid amplification testing (NAAT).

Methods

A Laboratory Usage Evaluation (LUE) tool was developed by the DNP student and a hospital infection preventionist to evaluate the 2020 CDS changes aimed at improving laboratory utilization in the detection of active pulmonary TB.

The tool was evaluated using the five rights framework of CDS: 1) The right evidence-based information, 2) The right people receive the information, 3) The right format is used, 4) The right channels, electronic health records, and user platforms are used, 5) The information arrives in the patient care workflow at the right time.

Results/key findings

Every hospitalized patient diagnosed with active pulmonary TB disease during the review period received an AFB and culture test. Not every hospitalized patient diagnosed with active pulmonary TB disease received NAAT.

The sample size was small (n=40), but there was evidence that the CDS tool improved the number of patients who received complete sets of TB tests, including AFB, culture, and NAAT (67% before CDS versus 81% after CDS).

Conclusion

Clinical decision support improved TB laboratory testing. Assessment with the five rights of CDS identified areas for improvement: providers did not always have access to CDS, the laboratory testing names were inconsistent, some devices may not have CDS, and CDS may not have been available in the right place in the workflow.  

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