Central Ohio Primary Care and Local Specialty Group Working Hand in Glove for Better Patient Outcomes! Rebecca Burk BS(QSM), Laboratory Manager, Central Ohio Primary Care Physicians, Inc. Contributing Author, Jennifer Coleman, MT(ASCP) Prostate Cancer Statistics 2015 American Cancer Society estimates for prostate cancer in the U. S. are: ~ 220,800 new cases of prostate cancer ~ 27,540 deaths from prostate cancer ~ 1 in 7 men will be diagnosed with prostate cancer -American Cancer Society 2015 1
Prostate Removal Predominant surgery to remove the prostate: Ultrasound guided trans-rectal biopsy Involves risk of infection by introducing bacteria from the rectum into the blood stream - A. N. Peeples, et. al. A Detection of Fluoroquinolone Resistant Organisms from Rectal Swabs. Department of Pathology and Laboratory Medicine, University of California Irvine Medical Center, Orange, CA, USA. Pre-Op Protocol Traditionally includes an enema or suppository And a dose of fluoroquinolone antibiotics (e.g. ciprofloxacin, levofloxacin) Reducing Post-Op Infections The bowel harbors bacteria that may be resistant to fluoroquinolone antibiotics. Screen for fluoroquinolone resistant bacteria Prescribe targeted prophylaxis to reduce chances of infection. - A. N. Peeples, et. al. A Detection of Fluoroquinolone Resistant Organisms from Rectal Swabs. Department of Pathology and Laboratory Medicine, University of California Irvine Medical Center, Orange, CA, USA. 2
The Task at Hand Providers at Central Ohio Urology Group inquired about COPC lab performing a screening procedure to identify patients with this type of resistance. Local hospital and ref labs did not want to adopt the protocol for COUG. COPC Laboratory (a POL) working with a procedure from Northwestern University, implemented this screening procedure. Hardy Diagnostics Cipro infused media. About the Procedure Patient swab is plated directly on Cipro infused MacConkey (Hardy Diagnostics' catalog G358), and BAP Plates are incubated 35-37C for 18-48 hrs. Any growth detected on Cipro/MAC plate is reflexed to Vitek for ID/AST. -Surveillance for Ciprofloxacin Resistant Gram Negative Bacteria using MacConkey Agar with Ciprofloxacin. Microbiology Laboratory Pathology Department Northwestern Memorial Hospital Chicago, Illinois. 3
Interpretation Inc Time MAC/Cipro BAP (QC) INTERP ID MIC INTERP 18-24 hrs Negative Positive Re-incubate 36-48 hrs Positive Positive Reflex Vitek ID GN Vitek AST Cipro MIC = Intermediate or Resistant Cipro Resistant Organism Isolated 18-24 hrs Negative Positive Re-incubate 36-48 hrs Positive Positive Reflex Vitek ID GN Vitek AST Cipro MIC= Sensitive No Cipro- Resistant Organism Isolated Negative and Positive Cultures Negative Culture BAP Control plates Positive Culture 4
A New Standard of Care at COUG This specialized screening culture has shown a positive impact on reducing post-op admissions due to sepsis caused by Fluoroquinolone resistant bacteria. Post implementation statistics from COUG demonstrate these positive findings: 17 septic patients admitted post op (June-Dec 2012) that either did not have the screening culture done, or had a positive culture but targeted prophylaxis was not given. Lessons Learned Not all POLs fit this description! COPC lab was not intimidated by what the hospital or reference labs Primary A POL is Care typically and Specialists thought of working as a small would Pre-op not screening do. We take with pride this in finding culture ways has add hand operation in glove within can achieve the walls better of a doctor s patient value, become improve standard quality, of and care contribute at COUG!! to better outcomes. office. patient outcomes. After all, these are our patients too!! 5
About COPCP The nation s 2 nd largest independent physician owned primary care group, serving 300,000 patients; with 240 outpatient providers and 60 hospitalists Level 3 PCMH certification at 44 sites and active as an Accountable Care Organization Focusing on helping our patients avoid expensive hospital stays with an innovative Transition of Care Program, Clinical Decision Units and Care Coordinators COPC Central Laboratory performs >5 million tests per year and is COLA-accredited. employs 50 staff; including technologists, lab assistants, CS staff and Billing About Central Ohio Urology Group COUG is one of the largest urology practices in Ohio. With 27 urologist working in the major hospital systems in Central Ohio, COUG offers a superior level of patient care through a wide range of subspecialties. This sub-specialization allows our physicians to be respected experts in their areas of study. COUG performs over 1000 ultrasound guided prostate biopsies per year. COUG Mission is to treat every patient with the care and respect they deserve, we truly strive to provide excellence in patient care. 6