Identification of Low-Risk Hospitalized Patients With Pneumonia: Definition of Need for Hospitalization
The occurrence of a significant medical complication served as a screen for a medically necessary hospitalization. After a complication was identified, the need for hospitalization was based on the physician’s implicit judgment in detail canadian neighbor pharmacy. The physicians who participated in this implicit review process included a pulmonologist (M.B.) and two general internists (M.N. and S. W.). Continued hospitalization was considered necessary if a patient developed a complication that would benefit from hospitalization. Continued hospitalization was considered potentially unnecessary if a patient did not develop a complication and had an uncomplicated hospital course.
Performance of Guideline
For testing the accuracy and validity of the practice guideline, the relative frequencies of life-threatening complications and death were compared between patients hospitalized in the low-and high-risk patient groups. Since patients were classified as at low or high risk according to the guideline 3 days after hospital admission, patients who suffered life-threatening complications within the first 3 days or patients who had a length of stay of 3 days or less were excluded from the analysis. The sensitivity, specificity, positive-predictive value, and negative-predictive value of the practice guideline were measured.
Complications of pneumonia (as defined for purposes of the study) included death, septic shock, empyema thoracis, lung abscess, an infection that necessitated prolonged parenteral therapy (eg, S aureus), the development of an extrapulmonary infection (eg, meningitis, endocarditis), the requirement of intravenous fluids for documented gastrointestinal upset, dehydration or hypotension, mental status changes, documented hypoxia requiring supplemental oxygen, acute myocardial infarction, sustained cardiac arrhythmias, or a significant change in preexisting comorbid illnesses, eg, diabetes mellitus.
All complications among low-risk patients that occurred more than 3 days after hospital admission were implicitly and independently reviewed by two board-certified internists. The physicians rated whether (1) conversion of patients from parenteral to oral antibiotic therapy on the third hospital day would have worsened patient outcomes and (2) whether the patient would have been adversely affected by being discharged on the fourth hospital day. Following initial independent review, the physicians discussed cases where there was disagreement and again judged whether compliance with the guideline would have worsened the quality of patient care.
Category: Respiratory Symptoms
Tags: antimicrobial therapy, congestive heart failure, healthcare costs, hospitalization, pneumonia