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Identification of low-risk hospitalized patients with pneumonia. Implications for early conversion to oral
S R Weingarten1, M S Riedinger, G Varis
1Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Research Institute, UCLA School of Medicine 90048.
Insights
A new guideline for pneumonia treatment may safely shorten antibiotic duration and hospital stays for low-risk patients. This approach could improve hospital capacity by freeing up beds.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Hospital Administration
Background:
- Limited data exist on optimal parenteral antimicrobial therapy duration and hospital length of stay for pneumonia patients.
- Current practices may lead to prolonged treatment and hospitalization for selected low-risk individuals.
Purpose of the Study:
- To evaluate the safety and effectiveness of a practice guideline for early conversion to oral antibiotics and hospital discharge in low-risk pneumonia patients.
- To assess the potential impact of the guideline on hospital resource utilization.
Main Methods:
- Retrospective study of 503 hospitalized pneumonia patients at a teaching community hospital.
- Application of a practice guideline to identify low-risk patients suitable for early oral antimicrobial therapy and discharge.
Main Results:
- 33% of pneumonia patients were identified as low-risk for complications.
- Implementing the guideline could have freed 619 hospital bed-days.
- Physician reviewers agreed that quality of care would not have worsened for 98.2% of patients switched to oral therapy on day 3 and 93.4% discharged on day 4.
Conclusions:
- The studied practice guideline shows potential for safely reducing parenteral antimicrobial therapy duration and hospital length of stay in selected low-risk pneumonia patients.
- Further investigation through a prospective clinical trial is recommended to validate these findings.
Purpose:
Few available data exist to define either the medically necessary duration of parenteral antimicrobial therapy or length of stay for hospitalized patients with pneumonia. Therefore, we investigated the potential safety and effectiveness of a practice guideline recommending early conversion of low-risk patients with pneumonia from parenteral to oral antimicrobial therapy and early hospital discharge.
Patients And Methods:
The practice guideline was studied retrospectively in 503 hospitalized patients with pneumonia at a teaching community hospital.
Results:
Thirty-three percent of patients with pneumonia were classified as at low risk for complications and potentially suitable for early conversion to oral antimicrobial therapy according to the guideline. Were the guideline to have been used to guide patient discharge decisions, 619 additional bed-days would have been made available to accommodate incoming patients. A consensus among physician reviewers led to the judgment that quality of care would not have worsened for 98.2 percent of low-risk patients had they been switched to oral antimicrobial therapy on the third hospital day, nor would quality of care have been worsened for 93.4 percent of low-risk patients had they been discharged on the fourth hospital day.
Conclusion:
The practice guideline that we studied has the potential to safely reduce the duration of parenteral antimicrobial therapy and length of hospital stay for selected low-risk patients with pneumonia. The guideline should be studied in a prospective clinical trial.