%0 Journal Article
%T Missed opportunities in TB diagnosis: a TB Process-Based Performance Review tool to evaluate and improve clinical care
%A Nigel Field
%A Jill Murray
%A Michelle L Wong
%A Rob Dowdeswell
%A Ntomboxolo Dudumayo
%A Lesego Rametsi
%A Neil Martinson
%A Marc Lipman
%A Judith R Glynn
%A Pam Sonnenberg
%J BMC Public Health
%D 2011
%I BioMed Central
%R 10.1186/1471-2458-11-127
%X The TB-PBPR tool is a single-page structured flow-sheet that identifies 14 clinical actions (grouped into elicited symptoms, clinical examination and investigations). Medical records from selected deceased patients were reviewed at two South African mine hospitals (A = 56 cases; B = 26 cases), a South African teaching hospital (C = 20 cases) and a UK teaching hospital (D = 13 cases).In hospital A, where autopsy was routine, TB was missed in life in 52% (23/44) of cases and was wrongly attributed as the cause of death in 16% (18/110). Clinical omissions were identified at each hospital and at every stage of clinical management. For example, recording of chest symptoms was omitted in up to 39% of cases, sputum smear examination in up to 85% and chest radiograph in up to 38% of cases respectively.This study introduces the TB-PBPR tool as a novel method to review and evaluate clinical performance in TB management. We found that simple clinical actions were omitted in many cases. The tool, in conjunction with a manual describing best practice, is adaptable to a range of settings, is educational and enables detailed feedback within a TB programme. The TB-PBPR tool and manual are both freely available for general use.The primary aims of tuberculosis (TB) control programmes are early diagnosis and prompt treatment of infectious cases to limit transmission [1]. To this end, the World Health Organisation (WHO) has developed specific outcome measures to evaluate TB control. Hence, treatment outcomes are recorded internationally and targets of 70% case detection and 85% cure in smear positive pulmonary TB have been set [2]. However, these broad outcome measures do not provide detailed insight into the pathways of clinical care or identify reasons for missing the targets.Methods of TB diagnosis have not changed significantly for many decades; resting primarily on clinical history, clinical examination, chest radiograph (CXR), and sputum smear and culture. Despite this long exper
%U http://www.biomedcentral.com/1471-2458/11/127