In beleaguered Atlanta, new boss cleans house
In beleaguered Atlanta, new boss cleans house
Morale is up and cases are plummeting
TB outreach workers in Fulton County, GA — the former epicenter of TB incidence in a state with the nation’s fifth-highest TB rates for the past two years running — are so diligent these days that their boss is giving them gold stars. Literally. For every day that the workers get all the requisite doses into all their patients, a gold star goes up beside their name on a posterboard chart hanging outside the nurses’ station. Workers with a patient who misses one dose get a blue star; below that, no stars are awarded.
"These gold stars are right there where everyone who walks past can see them, and it’s really working," says Pat Parrott, RN, formerly TB control coordinator at Grady Memorial Hospital and infection control coordinator for Atlanta’s Infectious Disease Clinic. "You’d think this would be something that would only work for first- and second-graders," says Parrott, "but it seems to be working really well for adults, too." Simple as it may sound, the new system is paying off in adherence rates. Computed on a daily basis for all patients in the system, the rates generally run between 97% and 98%.
The star chart is one of several innovations implemented by Jesse Jones, MD, Fulton County’s new TB controller. Since being appointed to the post a little over a year ago, Jones has made other changes that have sent morale soaring and cases plummeting, Parrott says. For one thing, Jones has implemented a badly needed system of data management and record-keeping. He’s also changed the way patients and physicians interact.
"One of the first things I did when I got here was to go through every patient chart and assign every patient to a specific doctor who follows them all the way through treatment," Jones says. Patients much prefer the continuity of care the new system affords; plus, doctors are held accountable, he points out.
Because Jones has lacked a complete set of data to look at until this quarter, he figures it’s a bit soon to be counting his chickens — or cases, in this instance. Still, it looks as if cases have dropped dramatically. From January to October 2000, Fulton County logged 146 cases; numbers for the same time period this year stand at 106, reflecting a 27% decrease. That could be coincidence, or it might reflect an interruption of ongoing transmission, Jones says. "We’re getting such good compliance that we’re not letting anyone infect someone else," he says.
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