SHM Converge Scientific Abstract ePoster Gallery-Streamlining Afb Collection: A Quality Improvement Project

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This quality improvement project addressed delays in tuberculosis (TB) diagnosis during hospitalization, which can increase nosocomial transmission, prolong isolation, extend length of stay (LOS), and strain hospital resources. Because TB evaluation requires sputum acid-fast bacillus (AFB) smear testing with samples collected every eight hours over 24 hours, delays in obtaining the required three consecutive negative smears can significantly slow discontinuation of isolation.<br /><br />The project aimed to reduce sputum AFB collection turnaround time (TAT) and decrease LOS by 10%. Interventions were implemented on two hospital floors, with one floor serving as a control. Changes included simplifying respiratory therapy (RT) sputum induction orders, standardizing nurse-to-provider communication when patients could not produce a sample within an hour, auto-documenting RT attempts and successes in the electronic health record, terminating induction after three unsuccessful attempts, and providing recurring interprofessional education and feedback.<br /><br />Stakeholders identified communication gaps and order-placement issues among nursing, RT, and hospitalist teams. Data were collected on time from order placement to submission of the final sputum sample and patient LOS. Analysis used unpaired t-tests.<br /><br />Results showed downward trends in both AFB TAT and LOS after the interventions, but these changes were not statistically significant. Mean AFB TAT decreased from 4,545 to 3,878 minutes, and mean LOS decreased from 14.29 to 13.93 days. Despite these improvements, observed times remained far above the theoretical 960-minute guideline-based TAT, indicating continued inefficiencies in the sputum collection process.<br /><br />Overall, the project suggests that standardized roles, systematic workflow changes, and interprofessional communication can improve efficiency, but consistent implementation and a larger sample size are needed to demonstrate meaningful impact.

Asset Subtitle

Zainah Siddiqi

Meta Tag

Author List Ankur Segon, Gregory Bowling, Roselle Sadornas, Sherry Saldua, Zainah Siddiqi

Category Research

Concept Diagnosis delay

Concept Sputum Acid-Fast Bacillus Collection

Concept Nosocomial Transmission

Concept Length of Stay

Concept Three Consecutive Negative Smears

Distinguished Non-Finalist

Presenter Organization UT Health San Antonio

Presenting Author Zainah Siddiqi

Track Quality Improvement

Keywords

tuberculosis diagnosis

hospitalization delays

nosocomial transmission

sputum AFB smear

isolation discontinuation

turnaround time

length of stay

respiratory therapy

interprofessional communication

quality improvement

Diagnosis delay

Sputum Acid-Fast Bacillus Collection

Nosocomial Transmission

Length of Stay

Three Consecutive Negative Smears