Do physicians examine patients in contact isolation less frequently? A brief report☆
Abstract
Background
Patients who are hospitalized and infected with multidrug-resistant bacteria are usually placed in contact isolation, which requires hospital personnel to gown and glove before patient examination. Contact isolation with active culture surveillance appears beneficial in preventing the spread of drug-resistant infections; however, contact isolation may impede the ability to examine patients as a result of the additional effort required to gown and glove. We assessed whether patients who are hospitalized and placed under contact precautions are examined less often by second- and third-year medical residents (ie, senior medical residents), and attending physicians during morning rounds.
Method
We conducted a prospective cohort study on the inpatient medical services at 2 university-affiliated medical centers. We directly observed senior medical residents and attending physicians during morning rounds, and recorded the contact precaution status of the patient and whether they were examined by either physician.
Results
Of a total of 139 patients, 31 (22%) were in contact isolation. Senior medical residents examined 26 of 31 patients (84%) in contact isolation versus 94 of 108 patients (87%) not in contact isolation (relative risk, 0.96; 95% confidence interval, 0.81–1.14; P = .58). In comparison, attending physicians examined 11 of 31 patients (35%) in contact isolation versus 79 of 108 patients (73%) not in contact isolation (relative risk, 0.49; 95% confidence interval, 0.30–0.79; P < .001).
Discussion
Attending physicians are about half as likely to examine patients in contact isolation compared with patients not in contact isolation.
aAnn Arbor Department of Veterans Affairs Medical Center, USA
bDepartments of Internal Medicine, University of Michigan, USA
dPatient Safety Enhancement Program, University of Michigan Health System, USA
Reprint requests: Sanjay Saint, MD, MPH, Division of General Medicine, University of Michigan Health System, Room 7E08, 300 NIB, Campus Box 0429, Ann Arbor, MI 48109-0429
☆ Supported by a career development award from the Health Services Research and Development Program of the Department of Veterans Affairs and a Patient Safety Developmental Center Grant from the Agency for Healthcare Research and Quality (P20-HS11540) (Dr Saint).
Presented, in part, at the National Association of Inpatient Physicians 4th Annual National Meeting, Atlanta, GA, March 2001.
ABSTRACT