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Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Improving follow-up testing in children with Shiga toxin-producing Escherichia coli through provision of a provider information sheet

Jack X. Pang A , Jaskaran Singh A , Stephen B. Freedman https://orcid.org/0000-0003-2319-6192 B D , Jianling Xie C and Jia Hu A
+ Author Affiliations
- Author Affiliations

A Population, Public, and Indigenous Health, Alberta Health Services, Calgary, AB T2N 1N4, Canada.

B Departments of Pediatrics and Emergency Medicine, Division of Pediatric Emergency Medicine, Alberta Children’s Hospital and Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada.

C Department of Pediatrics, Division of Pediatric Emergency Medicine, Alberta Children’s Hospital and Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada.

D Corresponding author. Email: Stephen.freedman@ahs.ca

Australian Journal of Primary Health 26(6) 479-483 https://doi.org/10.1071/PY20136
Submitted: 8 June 2020  Accepted: 12 October 2020   Published: 10 December 2020

Abstract

The aim of this study was to improve follow-up laboratory testing for children infected by Shiga toxin-producing Escherichia coli (STEC) through the provision of an information sheet to healthcare providers in the province of Alberta, Canada. An information sheet recommending the performance of laboratory tests, every 24–48 h until 3 days after diarrhoea resolves or the platelet count stabilises or begins to rise, was sent to all physicians who ordered a STEC-positive stool test as of 1 November 2016. The information sheet was only distributed to physicians in one of the province’s five healthcare delivery zones (i.e. intervention zone). Medical records for children aged <18 years with laboratory confirmed STEC-positive stool samples between November 2014 and November 2018 were reviewed to determine the performance of recommended laboratory tests. Post-intervention, follow-up testing in all categories increased significantly for cases that occurred in the intervention zone, with odds ratios (OR) ranging from 3.02 (95% CI: 1.35–6.78) to 3.94 (95% CI: 1.70–9.16) when compared with pre-intervention. No increase in any of the laboratory testing categories was detected outside of the intervention zone. The provision of a targeted information sheet to healthcare providers improved the monitoring of STEC-infected children.

Keywords: community health care, disease management, evidence-based practice, health education, quality of health care.


References

Ake JA, Jelacic S, Ciol MA, Watkins SL, Murray KF, Christie DL, Klein EJ, Tarr PI (2005) Relative nephroprotection during Escherichia coli O157:H7 infections: association with intravenous volume expansion. Pediatrics 115, e673–e680.
Relative nephroprotection during Escherichia coli O157:H7 infections: association with intravenous volume expansion.Crossref | GoogleScholarGoogle Scholar | 15930195PubMed |

Ardissino G, Tel F, Possenti I, Testa S, Consonni D, Paglialonga F, Salardi S, Borsa-Ghiringhelli N, Salice P, Tedeschi S, Castorina P, Colombo RM, Arghittu M, Daprai L, Monzani A, Tozzoli R, Brigotti M, Torresani E (2016) Early volume expansion and outcomes of hemolytic uremic syndrome. Pediatrics 137, e20152153
Early volume expansion and outcomes of hemolytic uremic syndrome.Crossref | GoogleScholarGoogle Scholar | 26644486PubMed |

Arditi C, Rege-Walther M, Durieux P, Burnand B (2017) Computer-generated reminders delivered on paper to healthcare professionals: effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews CD001175
Computer-generated reminders delivered on paper to healthcare professionals: effects on professional practice and healthcare outcomes.Crossref | GoogleScholarGoogle Scholar | 28681432PubMed |

Alberta Innovates (2017) ARECCI Ethics Guideline Tool. Available at https://albertainnovates.ca/wp-content/uploads/2017/11/ARECCI-Ethics-Guideline-Tool.pdf [Verified 21 May 2020]

Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR (1999) Why don’t physicians follow clinical practice guidelines? A framework for improvement. Journal of the American Medical Association 282, 1458–1465.
Why don’t physicians follow clinical practice guidelines? A framework for improvement.Crossref | GoogleScholarGoogle Scholar | 10535437PubMed |

Carson-Stevens A, Campbell S, Bell BG, Cooper A, Armstrong S, Ashcroft D, Boyd M, Prosser Evans H, Mehta R, Sheehan C, Sheikh A, Avery A (2019) Identifying ‘avoidable harm’ in family practice: a RAND/UCLA Appropriateness Method consensus study. BMC Family Practice 20, 134
Identifying ‘avoidable harm’ in family practice: a RAND/UCLA Appropriateness Method consensus study.Crossref | GoogleScholarGoogle Scholar | 31585529PubMed |

Chandler WL, Jelacic S, Boster DR, Ciol MA, Williams GD, Watkins SL, Igarashi T, Tarr PI (2002) Prothrombotic coagulation abnormalities preceding the hemolytic-uremic syndrome. The New England Journal of Medicine 346, 23–32.
Prothrombotic coagulation abnormalities preceding the hemolytic-uremic syndrome.Crossref | GoogleScholarGoogle Scholar | 11777999PubMed |

Cheung A, Weir M, Mayhew A, Kozloff N, Brown K, Grimshaw J (2012) Overview of systematic reviews of the effectiveness of reminders in improving healthcare professional behavior. Systematic Reviews 1, 36
Overview of systematic reviews of the effectiveness of reminders in improving healthcare professional behavior.Crossref | GoogleScholarGoogle Scholar | 22898173PubMed |

Cochrane LJ, Olson CA, Murray S, Dupuis M, Tooman T, Hayes S (2007) Gaps between knowing and doing: understanding and assessing the barriers to optimal health care. The Journal of Continuing Education in the Health Professions 27, 94–102.
Gaps between knowing and doing: understanding and assessing the barriers to optimal health care.Crossref | GoogleScholarGoogle Scholar | 17576625PubMed |

Davis TK, McKee R, Schnadower D, Tarr PI (2013) Treatment of Shiga toxin-producing Escherichia coli infections. Infectious Disease Clinics of North America 27, 577–597.
Treatment of Shiga toxin-producing Escherichia coli infections.Crossref | GoogleScholarGoogle Scholar | 24011831PubMed |

Freedman SB, Eltorki M, Chui L, Xie J, Feng S, MacDonald J, Dixon A, Ali S, Louie M, Lee BE, Osterreicher L, Thull-Freedman J (2017) Province-wide review of pediatric Shiga toxin-producing Escherichia coli case management. The Journal of Pediatrics 180, 184–190 e1.
Province-wide review of pediatric Shiga toxin-producing Escherichia coli case management.Crossref | GoogleScholarGoogle Scholar | 27745751PubMed |

Graber ML, Franklin N, Gordon R (2005) Diagnostic error in internal medicine. Archives of Internal Medicine 165, 1493–1499.
Diagnostic error in internal medicine.Crossref | GoogleScholarGoogle Scholar | 16009864PubMed |

Grisaru S (2014) Management of hemolytic-uremic syndrome in children. International Journal of Nephrology and Renovascular Disease 7, 231–239.
Management of hemolytic-uremic syndrome in children.Crossref | GoogleScholarGoogle Scholar | 24966691PubMed |

Grisaru S, Xie J, Samuel S, Hartling L, Tarr PI, Schnadower D, Freedman SB, for the Alberta Provincial Pediatric Enteric Infection Team (2017) Associations between hydration status, intravenous fluid administration, and outcomes of patients infected with Shiga toxin-producing Escherichia coli: a systematic review and meta-analysis. JAMA Pediatrics 171, 68–76.
Associations between hydration status, intravenous fluid administration, and outcomes of patients infected with Shiga toxin-producing Escherichia coli: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 27893870PubMed |

Hickey CA, Beattie TJ, Cowieson J, Miyashita Y, Strife CF, Frem JC, Peterson JM, Butani L, Jones DP, Havens PL, Patel HP, Wong CS, Andreoli SP, Rothbaum RJ, Beck AM, Tarr PI (2011) Early volume expansion during diarrhea and relative nephroprotection during subsequent hemolytic uremic syndrome. Archives of Pediatrics & Adolescent Medicine 165, 884–889.
Early volume expansion during diarrhea and relative nephroprotection during subsequent hemolytic uremic syndrome.Crossref | GoogleScholarGoogle Scholar |

Holme R (2003) Drinking water contamination in Walkerton, Ontario: positive resolutions from a tragic event. Water Science and Technology 47, 1–6.
Drinking water contamination in Walkerton, Ontario: positive resolutions from a tragic event.Crossref | GoogleScholarGoogle Scholar | 12638997PubMed |

Holtz LR, Neill MA, Tarr PI (2009) Acute bloody diarrhea: a medical emergency for patients of all ages. Gastroenterology 136, 1887–1898.
Acute bloody diarrhea: a medical emergency for patients of all ages.Crossref | GoogleScholarGoogle Scholar | 19457417PubMed |

Loconsole D, Giordano M, Laforgia N, Torres D, Santangelo L, Carbone V, Parisi A, Quarto M, Scavia G, Chironna M, Bloody Diarrhea Apulia Working Group (2020) Case-management protocol for bloody diarrhea as a model to reduce the clinical impact of Shiga toxin-producing Escherichia coli infections. Experience from Southern Italy. European Journal of Clinical Microbiology & Infectious Diseases 39, 539–547.
Case-management protocol for bloody diarrhea as a model to reduce the clinical impact of Shiga toxin-producing Escherichia coli infections. Experience from Southern Italy.Crossref | GoogleScholarGoogle Scholar |

McDonald CJ (1976) Protocol-based computer reminders, the quality of care and the non-perfectability of man. The New England Journal of Medicine 295, 1351–1355.
Protocol-based computer reminders, the quality of care and the non-perfectability of man.Crossref | GoogleScholarGoogle Scholar | 988482PubMed |

Morency-Potvin P, Schwartz DN, Weinstein RA (2016) Antimicrobial stewardship: how the microbiology laboratory can right the ship. Clinical Microbiology Reviews 30, 381–407.
Antimicrobial stewardship: how the microbiology laboratory can right the ship.Crossref | GoogleScholarGoogle Scholar | 27974411PubMed |

Panesar SS, deSilva D, Carson-Stevens A, Cresswell KM, Salvilla SA, Slight SP, Javad S, Netuveli G, Larizgoitia I, Donaldson LJ, Bates DW, Sheikh A (2016) How safe is primary care? A systematic review. BMJ Quality & Safety 25, 544–553.
How safe is primary care? A systematic review.Crossref | GoogleScholarGoogle Scholar |

Pantoja T, Grimshaw JM, Colomer N, Castanon C, Leniz Martelli J (2019) Manually-generated reminders delivered on paper: effects on professional practice and patient outcomes. Cochrane Database of Systematic Reviews CD001174
Manually-generated reminders delivered on paper: effects on professional practice and patient outcomes.Crossref | GoogleScholarGoogle Scholar | 31858588PubMed |

Patel MS, Volpp KG, Asch DA (2018) Nudge units to improve the delivery of health care. The New England Journal of Medicine 378, 214–216.
Nudge units to improve the delivery of health care.Crossref | GoogleScholarGoogle Scholar | 29342387PubMed |

Rowe PC, Orrbine E, Lior H, Wells GA, Yetisir E, Clulow M, McLaine PN (1998) Risk of hemolytic uremic syndrome after sporadic Escherichia coli O157:H7 infection: results of a Canadian collaborative study. Investigators of the Canadian Pediatric Kidney Disease Research Center. The Journal of Pediatrics 132, 777–782.
Risk of hemolytic uremic syndrome after sporadic Escherichia coli O157:H7 infection: results of a Canadian collaborative study. Investigators of the Canadian Pediatric Kidney Disease Research Center.Crossref | GoogleScholarGoogle Scholar | 9602185PubMed |

Singh H, Giardina TD, Meyer AN, Forjuoh SN, Reis MD, Thomas EJ (2013) Types and origins of diagnostic errors in primary care settings. JAMA Internal Medicine 173, 418–425.
Types and origins of diagnostic errors in primary care settings.Crossref | GoogleScholarGoogle Scholar | 23440149PubMed |

Smith ML, Raab SS, Fernald DH, James KA, Lebin JA, Grzybicki DM, Zelie C, West DR (2013) Evaluating the connections between primary care practice and clinical laboratory testing: a review of the literature and call for laboratory involvement in the solutions. Archives of Pathology & Laboratory Medicine 137, 120–125.
Evaluating the connections between primary care practice and clinical laboratory testing: a review of the literature and call for laboratory involvement in the solutions.Crossref | GoogleScholarGoogle Scholar |

van den Berge K, Mamede S (2013) Cognitive diagnostic error in internal medicine. European Journal of Internal Medicine 24, 525–529.
Cognitive diagnostic error in internal medicine.Crossref | GoogleScholarGoogle Scholar | 23566942PubMed |

Whitman G, Cowell V, Parris K, McCullough P, Howard T, Gaughan J, Karavite D, Kennedy M, McInerney J, Rose C (2008) Prophylactic antibiotic use: hardwiring of physician behavior, not education, leads to compliance. Journal of the American College of Surgeons 207, 88–94.
Prophylactic antibiotic use: hardwiring of physician behavior, not education, leads to compliance.Crossref | GoogleScholarGoogle Scholar | 18589367PubMed |

Wong CS, Jelacic S, Habeeb RL, Watkins SL, Tarr PI (2000) The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections. The New England Journal of Medicine 342, 1930–1936.
The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections.Crossref | GoogleScholarGoogle Scholar | 10874060PubMed |

Wong CS, Mooney JC, Brandt JR, Staples AO, Jelacic S, Boster DR, Watkins SL, Tarr PI (2012) Risk factors for the hemolytic uremic syndrome in children infected with Escherichia coli O157:H7: a multivariable analysis. Clinical Infectious Diseases 55, 33–41.
Risk factors for the hemolytic uremic syndrome in children infected with Escherichia coli O157:H7: a multivariable analysis.Crossref | GoogleScholarGoogle Scholar | 22431799PubMed |