Copies of example spreadsheets are available via the “Resources” page but here we illustrate some examples of the more complex comment development over time. As the clinical information on the request improves with time, so we are able to speak into the patients story and help in coming to the best possible management option on an individual basis but which collectively is then having the public health and even social benefits illustrated:
As demonstrated on the “What” tab, our comments have been moved up the report and take precidence over the sensitivities – we think this is the key determinant in educating the complex system and inducing behavioural change. For some common poor pactice requests, we have common responses e.g. “?UTI” illustrated below:
As the quality of the clinical information improves, so the detail in our part of the patient story will also improve as we seek to support the three party engagement (patient – clinician – laboratory):
88 year old male in urology patient who presented with urosepsis and was prescribed piperacillin-tazobactam initially. Initial comment flagged that the two Gram negative organisms at that time were sensitive. The consultant received a follow up call looking for an oral option as the patient was settling and offered a comment, which was finally followed by confirmation that the enterococcus was sensitive to amoxycillin.
78 year old male: This example illustrates how we can pick up a number of issues.
78 year old female: Here the patient has presented with symptoms that suggest a UTI but the microbiology could be interpreted as suggesting a contaminant. The emphasis here is not to say this is not a UTI but again to carefully weigh all the evidence in the light of the new result,
78 year old female where the only clinical information relates to dipstick results rather than any symptoms and/or signs. The fact that fosfomycin has been used may indicate that there were indeed symptoms but as has been expressed in other places, the worry is that dipsticking without symptoms is being viewed as indicating UTI.
71 year old males and the clinical information simply says: “Repeat.” This is unhelpful as knowing what has gone before takes time to understand. However, this is partnership in action. We can suggest the clinical information is inadequate to allow interpretation or we can try and be as helpful as possible. Seeking to do the best possible for the patient from our limited viewpoint is probably why we are getting the imapact we are seeing.
78 year old female: previous E coli infection, treated with pivmecillnam – further sample to check if now clear. There is no suggestion that the patient has symptoms and at this age, many such people’s normal state will be with bacteria in their bladder not causing any harm. Without the narrative, would the person receiving the result feel obliged to offer a further course of antibiotics and perpetuate problems?