Culture or Not?
Culture or not? is not a straightforward question. We tend to see specimen results while the rest of the team sees the whole patient.
Recently we talked to a hospitalist about a urine culture that had been collected by the ED as a reflex urinalysis prior to admission. Did he know it was positive?
He didn’t. He ended up theorizing about the dangers of needlessly treating patients and his concerns of contributing to antibiotic resistance.
“This patient isn’t symptomatic,” he explained. “She can be admitted from the nursing home with a positive culture and be put on cipro, return to the nursing home and eventually have another culture with the same results and treatment. Eventually, the bug becomes resistant and we’ve treated her for nothing.”
The ED doc had a different view. He said, “Often I find elderly patients don’t show clear symptoms. They may have less sensation, for example. I find if I don’t treat they return with a more serious infection or are septic, in which case they could crash.”
So, culture or not? The answer is less important than the lesson that our results aren’t interpreted in a vacuum and shouldn’t be reported from one. The more we know about what the physicians and nurses are looking for and why, the better we can help the patient. In this case, for example, we may have avoided expense and effort by communicating with the inpatient team sooner, recognizing that decisions often change.
As those who analyze specimens and report values used to make clinical treatment decisions, we should be on the front lines more often reviewing charts, verifying our reports are understood, and talking directly with doctors and nurses about collection and testing options. We should be a visible, approachable resource.
We tend to standardize processes, but patient care is dynamic. Traditionally we stay put behind doors testing and reporting, inside the black box with specimens going in one side and values out the other. I’m sure this makes report disclaimers, rejections, comments, and even test order appear arbitrary. Face to face communication can make the arbitrary purposeful.
NEXT: The Power of Touch