Invite in infectious disease docs to LTC
Once upon a time, I fell ill. I saw my internist, had an endoscopy and ended up in the ER because I was dehydrated. It was an infectious disease physician who saved the day, as he realized I likely had acute Epstein-Barr virus. Basically, I had fancy mono.
So if I'm predisposed to being fond of infectious disease physicians, it's because I believe they offer insight beyond that of a general practitioner. This is not to say that a long-term care facility's medical director can't handle a flu outbreak. But it is acknowledging that long-term care staff handles large caseloads with complex patients, and that more facilities should embrace partnerships with an ID physician.
These physicians can help address whether long-term care has an effective infection prevention plan and come up with answers to questions such as, “Do you admit residents with MRSA or C.diff?” says Steven K. Schmitt, M.D., FIDSA, FACP, a Cleveland Clinic physician and member of the Infectious Disease Society of America's Board of Directors. He's also the author of a paper on how infectious diseases speciality intervention relates to decreased mortality and lower costs.
“When you employ specialists to see patients and help with management and the course of care, you can prevent adverse events and save money on transportation, as well as deal with the issue of ER visits and readmissions,” he told me.
Long-term care also struggles on when to isolate a patient, or when contact precautions are in order.
“Some facilities treat MRSA like Ebola,” he said. “When you isolate, there are costs, and you need to make sure you have a good reason and to ask, ‘Is it truly realistic?' You have to make a judgement call and ask, ‘What are you really gaining?'”
He's also sympathetic to the contact precaution requirements for C. diff.
“A lot of times contact precautions are incorrectly adhered to, because you have to gown and glove,” he said. If there are multiple residents and a staff member is tearing off repeatedly, there is a lot of fatigue.
C. diff, MRSA and CRE remain hot topics for all healthcare providers, although the dreaded MERS is not a problem in long-term care — yet.
But even if a facility isn't ready to hire an ID physician, Schmitt reminds that infectious disease policies have to be consistent, especially around what healthcare workers are allowed to wear. There's been a lot of discussion recently around apparel in a healthcare environment, and providers are struggling with issues around nail length, hair and jewelry.
“Have a discussion, have a policy, and stick to it,” he says.
Finally, there has to be better systems of discharging residents with infectious diseases.
“Patients may leave to go home but still need care. It's important for nurses and caregivers to have communication with the ID doc,” he reminds.
Elizabeth Newman is Senior Editor at McKnight's. Follow her @TigerELN.