Identification of Low-Risk Hospitalized Patients With Pneumonia: Data Quality
Projected Effects of Practice Guideline Utilization
A total of 33 percent of patients (n=166) with pneumonia admitted to the hospital were suitable for early discharge. The average length of stay for these patients was 7.73 ±6.12 days. Had these patients been discharged after 4 hospital days, 619 additional hospital bed-days would have been available on an annual basis to accommodate incoming patients.
Reproducibility of the guideline classification results was measured. The interrater agreement was 91 percent (kappa 0.80), which demonstrated very good reproducibility of the guideline.
In cases where there were complications, the medical records were implicitly reviewed by two physicians. The physician reviewers independently agreed on whether a patient would have been adversely affected by early conversion to oral antimicrobial therapy for 76 percent of cases (kappa 0.28). Following discussion on this issue, the agreement between reviewers was 100 percent (kappa 1.0). In addition, the physician reviewers independently agreed on whether early discharge would have adversely affected the quality of care for 71 percent of cases (kappa 0.39). Following discussion between the reviewers on this issue, consensus was achieved in 100 percent of cases (kappa 1.0).
Patients hospitalized with pneumonia commonly receive parenteral antimicrobial therapy for approximately 7 days and then are converted to oral antimicrobial therapy buy claritin online. There are few published data to support or refute this commonly followed medical practice, nor are there available data to guide physicians’ decisions about the optimal length of parenteral antimicrobial therapy and hospital length of stay. Our present guideline differs from our previous one in that we included patients with Gram-negative bacillary pneumonia, since several recent trials have demonstrated that some patients with Gram-negative bacillary pneumonia can be treated with oral antimicrobial therapy. Our study demonstrated that many hospitalized patients who have pneumonia can potentially be switched from parenteral to oral antimicrobial therapy on the third hospital day, and a significant number of these patients can be safely discharged from the hospital on the fourth hospital day. Since current medical practice significantly differs from our recommendations, use of this guideline has the potential to significantly reduce healthcare costs.
Category: Respiratory Symptoms
Tags: antimicrobial therapy, congestive heart failure, healthcare costs, hospitalization, pneumonia