Impact of a Coordinated Tuberculosis Team in an Inner-City Hospital in New York City

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Abstract
Objective: To evaluate the impact of a coordinated approach for the isolation, diagnosis, and treatment of patients with tuberculosis. Design: Retrospective cohort study. Setting: Bronx-Lebanon Hospital Center, an innercity hospital in the South Bronx, New York City. Patients: Patients with smear-positive, culture-confirmed pulmonary tuberculosis. Interventions: Institution of a coordinated tuberculosis team. Results: Admissions of 46 patients before and 39 patients after the formation of a tuberculosis team were reviewed. Before institution of the tuberculosis team, 35% of patients were isolated within 24 hours of presentation, 41% never were isolated, and the mean number of days patients were not isolated was 19. After implementation of the tuberculosis team, 59% of patients were isolated within 24 hours, only 5% were never isolated, and the mean number of days patients were not isolated was 3.5. These differences were statistically significant. There also was a corresponding decrease in length of hospitalization. In addition, there were noticeable improvements in patient and staff morale and attitudes. Conclusions: The tuberculosis team likely has decreased the risk of nosocomial tuberculosis transmission by increasing the proportion of infectious tuberculosis patients admitted into AFB isolation and by reducing (by 780) the number of days out of isolation while smear positive. There also were concomitant financial savings.

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