Post–sign-off events in infectious disease consultation and the incidence of nonadherence to infectious disease recommendations in the post–sign-off period: A retrospective cohort study

OBJECTIVE: Infectious diseases (ID) consultation has contributed to improving outcomes in hospitalized patients. However, the timing of signing off on ID consultation varies, depending on the consulting ID physician. We studied the descriptive epidemiology of treatment-related adverse events (ADEs) occurring after the ID physician has signed off on consultation and the epidemiology and predictors of nonadherence to ID recommendations in the post–sign-off period. METHODS: This retrospective cohort study was conducted at a Japanese tertiary-care center. All patients who received ID consultation between January and December 2019 and treatment recommendations for a confirmed or suspected infectious disease were included. The incidence of any treatment-related ADE after signing off, nonadherence to the final ID recommendations, and factors associated with nonadherence to the ID recommendations were identified. RESULTS: In total, 367 patients receiving ID consultation were included. The incidence of post–sign-off events during index hospitalization was 59 (16.1%) of 367, with antimicrobial-associated ADEs accounting for 26 events (44.1%) and HAIs accounting for 13 events (22.0%). After excluding patients who discontinued treatment, nonadherence to ID recommendations was identified in 55 (15.7%) of 351 patients. Newly acquired HAIs during the index hospitalization after signing off on ID consultation was an independent risk factor for nonadherence to ID recommendations (adjusted odds ratio, 3.78; 95% confidence interval, 1.14–12.52). CONCLUSIONS: Post–sign-off events were common and led to nonadherence to ID recommendations during the post–sign-off period. Because this nonadherence occurs for various reasons, patients may require continued attention after signing off to ensure their safety.