Increasing evidence-based care practices for patients with <i>Staphylococcus aureus</i> bacteraemia through required infectious diseases consultation in a tertiary care hospital: a quality improvement initiative
Bibliographic record
Abstract
Background Staphylococcus aureus bacteraemia had a higher mortality rate than average at Kingston Health Sciences Centre (KHSC). Infectious diseases specialist consultation has been shown to improve outcomes for S. aureus bacteraemia by increasing adherence to evidence-based care practices. Yet, infectious disease specialists were not involved in many cases at KHSC. Aim To improve adherence to evidence-based care practices by increasing the proportion of patients with S. aureus bacteraemia who receive a formal infectious diseases consultation. Interventions A multimodal intervention consisting of (1) daily automated email of positive blood culture results to the infectious diseases team; (2) standardisation of prompts attached to positive blood culture results on the electronic medical record; (3) policy of mandatory infectious diseases consultation and (4) education of resident physicians. Implementation and evaluation The outcome measure was adherence to evidence-based care practices, defined as echocardiography, repeating blood cultures and treatment with a first-line antibiotic. A secondary outcome measure was 90-day mortality. The process measure was the proportion of patients receiving formal infectious diseases consultation. A balancing measure was hospital length of stay. All measures were monitored semimonthly using statistical process control charts for time periods before and after intervention. Results There were 171 and 186 patients with S. aureus bacteraemia in the preintervention and postintervention period, respectively. Between these two periods, the proportion of those who received evidence-based care practices increased from 73% to 82% (p=0.031) and demonstrated special cause variation. Mortality changed from 29% to 24% (p=0.400). The proportion of patients receiving an infectious diseases consultation increased from 47% to 90% (p<0.001) and demonstrated special cause variation. The median (IQR) length of stay was 18 (11–30) days and 17 (11–42) days in the preintervention and postintervention period, respectively (p=0.442). Conclusions A multimodal intervention that implemented mandatory infectious diseases consultation significantly improved evidence-based care practices for S. aureus bacteraemia.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".