Thanks Wendell. I agree. I did talk to the person over Intensive Care and Pediatrics. He was sympathetic, but a bit defensive. Kept saying I need to own part of it.
It's not about blame or taking ownership, etc.; it's about realizing there is a problem and fixing it. Like you said, the handoff needs to be better.
I am big on systems. Telling everyone to do the handoff better is a behavioral change. Just like when we chastise or try to teach the ED physicians to not do a U/A reflex on urines on two-year-olds or younger or especially cathed specimens. Any pending lab result has to get sent to the PCP as well as the hospitalist. Where was the ordering physician? The ED doctor?
I remember with the U/A and cultures (regardless), the head of microbiology and I came up with the perfect solution. But, no one went with it. CPOE has many places where your selection brings up a window to either stop you or educate you. For instance, try ordering IV Vanco. You can but only after your check off a few boxes that tells the pharmacy why you need to use it. Should be the same with ordering a urinalysis on any child under five or whatever cutoff. Either educate them that young children and infants don't localize their infection plus a UTI in a nine-month-old is much worse than in a 16 yo. Maybe make it mandatory unless you give another reason for the U/A and U/A micro such as hematuria or proteinuria. But, no, they just keep ordering U/A reflexes and putting them on amoxicillin and Bactrim so the UTI has a 50% chance or greater of being resistant. Can't use cefprozil, that would make too much sense. But, I digress.
