Patients suspected of having tuberculosis (TB) need specific precautions within healthcare settings, particularly as TB cases have been increasing in the US in recent years. These precautions involve placing individuals with suspected TB in specialized rooms designed to handle airborne infections, known as airborne infection isolation rooms.
To enhance our ability to evaluate patients for possible TB infections, we created a TB risk scoring tool by analyzing historical patient data. This tool was subsequently incorporated into the electronic health record under the name “TB or Not TB.”
The tool assists healthcare providers in determining, after they have completed and received negative results from the TB workup, whether it is safe to stop infection control measures. This ensures proper decisions regarding TB isolation, reduces the workload on clinicians, and improves the overall patient experience.
This tool has been validated and is currently implemented at all MGB locations.
Background:
Infection Prevention and Control (IPC) programs are responsible for ensuring proper isolation of patients with suspected or confirmed contagious diseases to minimize the risk of infections in healthcare settings and protect the safety of healthcare workers.
Nonetheless, isolating patients can create challenges related to clinical workflows, accessibility to care, and hospital capacity, underscoring the need for effective and safe protocols for ending isolation. There is an increasing demand for system-based solutions for isolation and de-isolation, including clinical decision support tools, to:
- Ensure safety for patients and healthcare workers
- Lessening the cognitive and administrative load on healthcare professionals
- Boost the well-being of clinicians
A group of infection prevention specialists, infectious disease doctors, and researchers at Massachusetts General Hospital (MGH) devised a risk scoring tool by reviewing records of previous patients diagnosed with TB along with those who were considered at risk but did not have TB. They developed a validated model to evaluate the probability of TB infection before lifting isolation precautions.
That same team collaborated with digital health and clinical informatics developers to incorporate the scoring model into the electronic health record, creating the tool “TB or Not TB.”
If a patient is flagged for TB evaluation, they are marked as “TB-Risk,” prompting the necessary isolation in a specialized hospital room along with the use of personal protective equipment. Once the healthcare provider is convinced that TB is no longer a potential issue based on the patient’s symptoms, test outcomes, and/or risk factors, they can utilize the TB or Not TB tool to assess whether it’s safe to lift isolation precautions.
What are the Clinical Implications and Next Steps?
This tool is expected to enhance both patient care and clinician workflows. A thorough analysis of TB evaluations within the MGB system over six years demonstrated that the tool accurately identified all cases where TB infection was present, ensuring those patients remained safely isolated while undergoing testing.
Additionally, the tool was able to correctly identify about 25% of cases where TB was highly unlikely. This allows those patients to safely and efficiently exit isolation, potentially increasing bed availability, easing clinician workloads, reducing time spent on infection control consultations, and improving the patient experience.
