Relationship Between the Use of Preprinted Physician Orders for Hospital-Acquired Fever and Time to Blood Culture Collection: A Single-Center Retrospective Cross-Sectional Study

Abstract

Taku Harada,1,2 Shintaro Kosaka,3 Juichi Hiroshige,1 Takashi Watari4,5 1Division of General Medicine, Showa Medical University Hospital, Tokyo, Japan; 2Division of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan; 3Department of Internal Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan; 4General Medicine Center, Shimane University Hospital, Shimane, Japan; 5Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USACorrespondence: Taku Harada, Division of General Medicine, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu Koto-ku, Tokyo, 135-8577, Japan, Tel [phone], Fax [phone], Email [email protected]: Fever is relatively common in patients admitted to general wards. There is no standardized approach, and little is known about how physicians respond to fever. Additionally, preprinted physician orders are routinely used clinically in hospital medicine, and it is not clear how preprinted physician orders for fever affect the care of patients with fever. Therefore, we aimed to determine whether preprinted physician orders for inpatients have an effect on the time from fever measurement to blood culture collection.Patients and Methods: This was a single-center, retrospective, cross-sectional study of patients with bacteremia. Between January 1, 2015 and December 31, 2019, 137 hospitalized febrile patients diagnosed with bacteremia by blood culture prepared from blood collected 72 h after hospitalization were included.Results: Preprinted physician orders with instructions to call the physician if the patient has a fever were present for 59 patients. For preprinted physician orders with instructions to notify the physician about fever onset, 62.7% of the blood cultures were collected within 1 h of fever observation; when preprinted orders were not used, only 23.1% met the 1-h collection criterion. Multivariate analysis showed that preprinted physician orders were significantly associated with blood culture collection within 1 h from the reporting of fever (odds ratio, 4.94; 95% confidence interval, 2.27– 10.70).Conclusion: Preprinted physician orders with instructions to notify the physician about fever onset were present for only 40% of our sample, and this was related to the time of blood culture collection.Keywords: hospital-acquired fever, preprinted physician orders, bacteremia

Keywords

• hospital-acquired fever
• preprinted physician orders
• bacteremia