NORTHWICK-PARK-INFECTION-CONSULTATION-SERVICE .2. CONTRIBUTION OF THE SERVICE TO PATIENT-MANAGEMENT - AN ANALYSIS OF RESULTS BETWEEN SEPTEMBER 1987 AND JULY 1990

The establishment of Infectious Disease teams combining microbiological and clinical expertise has recently been recommended by a joint working part of the Royal College of Physicians and the Royal College of Pathologists. The Northwick Park Infection Consultation Service (ICS) has been operating on these lines since 1983; details are given in Part I. Part II assesses the contribution that the ICS has made to the management of infection in a study of 1038 patients undertaken between September 1987 and July 1990. The areas of patient diagnosis, treatment, investigation and isolation were examined to assess the appropriateness of the attending doctor's management of infection and the benefits resulting from recommendations made by the ICS. At the time of consultation the correct diagnosis had already been made or considered in 93 % of patients, essential investigations needed to confirm or refute the diagnosis performed in 92 %, and side-room isolation correctly instituted in 81 % of patients requiring it. However, 41 % of 776 infected patients were receiving suboptimal treatment: this was significantly more frequent in unsolicited consultations (P < 0·05). Advice was given following consultation in 893 of 1038 patients (86 %) and related to treatment (66 %), investigation (41 %), diagnosis (30%) and patient isolation (4 %). Of 844 patients where receipt of advice could be accurately assessed, it was taken fully in 708 (84%), partly in 111 (13 %), and went unheeded in 25 (3 %). Advice on diagnosis or investigation enabled the correct diagnosis to be reached in 30 % of consultations and in a further 47 patients (5 %), the diagnosis was proposed by the ICS on initial consultation. We believe that the results of this study substantiate the recommendation of the joint working party that Infectious Disease teams should be established in each health district. © 1991 The British Society for the Study of Infection.