Collaboration with school nurses - Improving the effectiveness of tuberculosis screening

Objective: To compare tuberculosis skin test (TST) reading rates between ch ildren whose tests were read by school nurses following specific requests b y physicians and those who relied on their parents to get their tests read, either at school or at the physician's office. Design: A randomized controlled trial. Setting: An urban hospital-based pediatric practice. Participants: Healthy low-income Hispanic and African American children age d 5 to 17 years whose physicians ordered TSTs at their routine physical exa minations. Subjects attended 1 of 68 public schools. Nurses at these school s were willing to read student TSTs, and received instructions about how to read and report the results back to the physician's office. Intervention: Subjects were randomized to a control group (routine TST plac ement, with no physician-to-school nurse communication) or to an interventi on group (routine TST placement, with physician-to-school nurse communicati on). Main Outcome Measures: Tuberculosis skin test reading rates between the 2 g roups were compared. Impediments to TST reading and reporting were investig ated. Results: One hundred thirty-four children were enrolled, 54 (40%) in the co ntrol group and 80 (60%) in the intervention group. More patients in the in tervention group had their TSTs read by 72 hours compared with those in the control group (74 [92%] vs 30 [56%]; P < .001). The low reading rate in th e control group was best attributed to communication failures. Conclusion: Systematic collaboration with school nurses can increase TST re ading rates.