TB Clinical Workflow

This page covers TB Clinic-specific workflows (case registration, DOTS, contact tracing, escalation). Shared front-door mechanics are defined in OPD Patient Journey↴ and OPD Referral & Escalation↴.

Case Management Flows

New TB Case

Overall TB Case Management Flow

1

Case received (PR1/PR2)

Patient screened by OPD, Fever Clinic, Triage or Referral team. TB case form initiated.

2

Register in TBIS 101D Logbook

Register

Registration into manual TB registry. Record PR1/PR2 code, date, name & details.

3

Refer to MO (Medical Officer)

Assessment begins in SystmOne. Use Template: New Case TB Management.

4

Initiate TB treatment

Start Rx

Start daily regimen (Category I/II).

5

Provide Health Education

Explain disease, medication, risk factors. Tick checklist in manual & SystmOne.

6

Document Follow-Up Plan (TBIS 10E)

Enter follow-up appointment in manual + SystmOne calendar.

7

1 Month Review

In Progress

Chest X-Ray, Sputum AFB, check for complications.

8

Continue Regimen + 2-Month TCA

In Progress

If stable, continue medication. Repeat CXR, sputum; consult FMS if needed.

9

4-Month Review (MO/FMS)

In Progress

Assess sputum/CXR again. Mark DOTS continuation.

10

6-Month Review for Cure Evaluation

Sembuh

Final sputum ×2, chest X-ray. If negative & no complications → declare Sembuh.

11

If Not Cured

Belum Sembuh

Extend regimen 3 months. New TCA with MO/FMS.

12

Discharge Plan (Cured Case)

Discharged

TCA at 3, 6, 9 months post-treatment.

Monthly TB Visit

Monthly TB Case Follow-Up in SystmOne

1

Patient Arrival

Patient arrives for follow-up session. Register in SystmOne / CCMS.

2

TB Counter Assessment

In Progress

TB Counter Staff:
• If CXR needed → Create CXR Order
• If blood screening needed → Collect blood sample per protocol
• Template: JKN Assessment & Procedure > TB Clinic Tab
• Mark completed tests & update checklist

3

CXR Test (if ordered)

Patient proceeds to Room 7 for X-ray examination.

4

Doctor's Room

In Progress

Record Vital Signs & Anthropometry. Document results in SystmOne.

5

Consultation & Treatment

In Progress

Conduct consultation & treatment session.
• Template: Follow-Up Case TB
• Template: JKN Assessment & Procedure
• Prescribe medication & write MC in SystmOne
• Set TCA date in SystmOne

6

Medication Collection

Staff collect medication at Pharmacy.

7

Discharge

Finished

Patient discharged. Record attendance in NTBA & SystmOne.

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Various TB Clinic Patient Flow

Collections of algorithms and flowcharts for different settings of TB management:

1. General Flow TB Patient in the Clinic

Updated

TB General Flow

2. Management of New TB Case Flowchart

Visual

TB New Case Management

3. Detailed Checklist & Workflow for TB Management

Checklist

TB Checklist

4. Monthly TB Case Follow-up SOP in CCMS

TB Monthly Followup

5. TB Contact Tracing SOP

TB Contact Tracing

6. DOTS SOP in Systmone

Aug 25, 2025

TB DOTS

7. TB Screening SOP

TB Screening SOP

8. High Risk Group Screening for TB (HRG)

TB HRG Screening

9. Mantoux Testing for TB

TB Mantoux

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Escalation & Referral

1. Escalation at OPD / Primary Contact Level

Medical Officers at the outpatient department or other units are responsible for initiating early investigation for suspicious cases and appropriate referral to the TB Clinic.

TB-Specific Referral Triggers:

1. Patient presents with suggestive symptoms → Initiate sputum AFB and/or CXR
2. Patients fall under High-Risk Group (HRG) criteria → Refer to TB Clinic for HRG TB Screening
3. If patient is a known TB case under follow-up from another district or facility, refer to TB MO for transfer-in case verification, medication continuation, and appointment alignment
4. MO OPD is advised to consult TB Clinic MO for any case involving suspicion, diagnostic difficulty, or follow-up uncertainty

Referral Best Practice

Effective TB management requires timely escalation and referral to ensure patients are appropriately diagnosed, managed, and followed up.

2. Referral from TB Clinic to Chest Clinic / TB Specialist

Refer patients to the Hospital Chest Clinic when:

Indication	Referral Reason
Smear-positive after 5 months	Suspected treatment failure or drug resistance
MDR-TB suspected or confirmed	Requires specialist care, often with hospitalization
Severe extrapulmonary TB (CNS, bones)	Requires advanced imaging, biopsy, or surgical input
TB in HIV-positive patients (complicated)	Multidisciplinary management needed
Pediatric/congenital TB cases	Requires pediatric ID or chest specialist input

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Defaulter Tracing Protocol

When a TB patient misses an appointment or medication collection, the following TB-specific escalation pathway is activated.

Step	Action	Responsible
Day 1	Identify defaulter type (treatment vs review). Initiate phone call, letter, or home visit if justified	TB Clinic nurse / MA
Day 3	If patient has not returned, home visit is mandatory	TB Clinic nurse / MA
Retrieved	Counselling, family education, restart/continue treatment, register back into DOTS/VOT, record in SystmOne	TB MO + TB Clinic nurse / MA
Not retrieved	Mark as Loss to Follow-Up (LTFU) in SystmOne & MOH TB portal. Notify PKD / Public Health	TB MO

Defaulter Tracing Priority

High-risk defaulters (e.g., smear-positive pulmonary TB, MDR-TB contacts, or paediatric cases) should be escalated for home visit within 24 hours instead of Day 3.