Suspected Underdiagnosis of Respiratory Syncytial Virus in a Large Health System: Early Findings From Electronic Health Record Data Exploration and Conversations With a Hospitalist

Background: Respiratory syncytial virus (RSV) is a common virus that infects the lungs and breathing passages. Although it manifests as mild cold-like symptoms in healthy adults and children, RSV can be life-threatening among infants, the elderly and immunocompromised adults. We set out to describe the adult-patient experience with RSV, examining rates of diagnosis within a large health care system, but quickly learned that the project could not be completed without one stakeholder’s (a hospitalist) experience with RSV. Methods: We conducted a retrospective cohort study of hospitalized adults (age: 18+ years) with a diagnosis of RSV within a large health system from October 1, 2013, to June 1, 2016. RSV was identified by evidence of one or more diagnosis codes (ICD-9: 079.6, 466.11 and 480.1; ICD-10: B97.4, J12.1 and J21.0) and/or positive laboratory findings for panels including RSV. Results: We identified 72 cases of diagnosed RSV across 24 Sutter Health hospitals during the study period. RSV patients averaged 74 years (standard deviation: 18.6); 47 (65%) were female; 47 (65%) were white, 10 (14%) were Asian, and the remaining 15 (21%) were other minority. Cases of RSV were disproportionate among hospitals across the system; one hospital accounted for 55 (76%) cases. A hospitalist at this site confirmed that in 2014, this facility began ordering a new respiratory viral panel offered only through the local public health department. This test, not available at other hospitals, screens for influenza and other respiratory infection including RSV. Conclusion: The clinical features of RSV may be difficult to distinguish from influenza and bacterial respiratory infections. Although there are currently no specific treatments available for RSV, it is important to distinguish between viral and bacterial origins to minimize inappropriate use of antibiotics. The disparate counts of RSV at the single hospital allowed us to recognize underdiagnosis in our system. We began our study with the objective to describe the RSV patient journey, but adapted to describe its patterns of diagnosis in a multihospital health system, including a pre-post implementation of respiratory viral panel testing analysis. Our study highlights the impact of engaging subject matter experts as key stakeholders early in the process