Thursday, December 5, 2019

Re- visiting the panculture and other thoughts

I really enjoyed this clever article titled Re- Visiting the Panculture, available here. The authors, Valerie Vaughn and Vineet Choprak, highlight the waste associated with reflexive panculturing of febrile patients. The call for a more 'mindful' approach to the evaluation of fever  is spot on.

The above concept is applicable to this more recent publication titled Knowledge and practices of physicians and nurses related to urine cultures in catheterized patients: An assessment of adherence to IDSA Guidelines.

So, can we be more mindful when assessing a febrile patient?  

Yes, but education and feedback to  providers only goes so far in my experience. This must be coupled with electronic medical record decision support mechanisms which prompt physicians to practice more guideline concordant care. Sometimes, forcing functions are needed, such as an electronic medical record hard stop on Clostridium difficile test ordering for patients with diarrhea and on laxatives.

Erosion of  provider autonomy is not inconsequential, and should employed selectively at most,  such as when patient safety and resource stewardship is on the line.