RESPIRATORY ISOLATION OF TUBERCULOSIS PATIENTS USING CLINICAL, GUIDELINES AND AN AUTOMATED CLINICAL DECISION-SUPPORT SYSTEM

OBJECTIVE: To evaluate a clinical guideline and an automated computer protocol for detection and respiratory isolation of tuberculosis (TB) patients. DESIGN: An automated computer protocol was tested on a retro spective cohort of adult culture-positive TB patients admitted from 19 92 to 1993 to Columbia-Presbyterian Medical Center and evaluated prosp ectively from July 1995 until July 1996. SETTING: A large teaching hos pital in New York City. PATIENTS: 171 adult patients admitted from 199 2 to 1993 and 43 patients admitted between July 1995 and July 1996. IN TERVENTIONS: The 1990 Centers for Disease Control and Prevention guide lines for preventing transmission of TB were adapted to formulate clin ical guidelines to ensure early isolation of TB patients at Columbia-P resbyterian Medical Center. RESULTS: Implementation of a clinical resp iratory isolation protocol resulted in a significant improvement in TB patient isolation rates, from 45 (51%) of 88 in 1992 to 62 (75%) of 8 3 in 1993 (P<.001). In testing automated protocols, the theoretical im provement would have identified an additional 27 patients not isolated by clinicians, making the overall isolation rate 134 (78%) of 171. Fo r the prospective evaluation, 30 (70%) of 43 TB patients were isolated by clinicians adhering to the clinical protocol. Four additional pati ents were identified by the automated TB protocol, making the combined isolation rate 34 (79%) of 43. CONCLUSIONS: A clinical policy to isol ate TB patients and suspected human immunodeficiency virus-infected pa tients with cough, fever, or radiographic abnormalities improved isola tion of culture-documented TB patients from 1992 to 1993. Automated co mputer protocols were successful in identifying additional potentially infectious patients that clinicians failed to place on respiratory is olation. Clinical and automated protocols combined resulted in better isolation rates than a clinical protocol alone.