Open Access Research article

"Cough officer screening" improves detection of pulmonary tuberculosis in hospital in-patients

Ching-Hsiung Lin1, Cheng-Hung Tsai1*, Chun-Eng Liu2, Mei-Li Huang3, Shu-Chen Chang4, Jen-Ho Wen1 and Woei-Horng Chai1

Author Affiliations

1 Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanshiao Road, Changhua, Taiwan

2 Division of Infectious Disease, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanshiao Road, Changhua, Taiwan

3 Infection Control Committee, Changhua Christian Hospital, 135 Nanshiao Road, Changhua, Taiwan

4 Department of Nursing, Changhua Christian Hospital, 135 Nanshiao Road, Changhua, Taiwan

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BMC Public Health 2010, 10:238  doi:10.1186/1471-2458-10-238

Published: 10 May 2010

Abstract

Background

Current tuberculosis (TB) reporting protocols are insufficient to achieve the goals established by the Stop TB partnership. Some countries have recommended implementation of active case finding program. We assessed the effect of Cough Officer Screening (an active screening system) on the rate of TB detection and health care system delays over the course of four years.

Methods

Patients who were hospitalized at the Changhua Christian Hospital (Changhua, Taiwan) were enrolled from September 2004 to July 2006 (Stage I) and August 2006 to August 2008 (Stage II). Stage II was implemented after a Plan-Do-Check-Act (PDCA) cycle analysis indicated that we should exclude ICU and paediatric patients.

Results

In Stage I, our COS system alerted physicians to 19,836 patients, and 7,998 were examined. 184 of these 7,998 patients (2.3%) had TB. Among these 184 patients, 142 (77.2%) were examined for TB before COS alarming and 42 were diagnosed after COS alarming. In Stage II, a total of 11,323 patients were alerted by the COS system. Among them, 6,221 patients were examined by physicians, and 125 of these patients (2.0%) had TB. Among these 125 patients, 113 (90.4%) were examined for TB before COS alarming and 12 were diagnosed after COS alarming. The median time from COS alarm to clinical action was significantly less (p = 0.041) for Stage I (1 day; range: 0-16 days) than for Stage II (2 days; range: 0-10 days).

Conclusion

Our COS system improves detection of TB by reducing the delay from infection to diagnosis. Modifications of scope may be needed to improve cost-effectiveness.