Identification of Low-Risk Hospitalized Patients With Pneumonia: Discussion
During the first 3 days of hospitalization, an increasing amount of information becomes available to physicians including the pathogen causing the episode of pneumonia (in some cases) and the patient’s initial response to antimicrobial therapy. This information can be used by physicians to make better informed decisions about the optimal duration of parenteral antimicrobial therapy and hospital length of stay. Objective, valid, and reliable criteria for selecting patients for early conversion can greatly improve the acceptability and safety of this strategy to control healthcare costs while enhancing or maintaining the quality of care at the same time. The average length of stay for patients with pneumonia is currently 8.3 days. Since length of stay is one of the most important determinants of hospital costs, appropriate reductions in hospital lengths of stay could significantly reduce medical expenditures. The rapid identification of those hospitalized patients who have pneumonia who are suitable for conversion from parenteral to oral antimicrobial therapy may lead to more timely hospital discharge. In our study, we found that had low-risk pneumonia patients been discharged on the fourth hospital day, their instability upon discharge (which relates to the probability of postdischarge mortality) would have been lower than that of a large population of Medicare patients in a recently reported study. The low instability score of these low-risk patients further supports the hypothesis that selected patients could potentially be discharged on the fourth hospital day. Studies have demonstrated that a significant number of hospitalized patients who have pneumonia may have medically unnecessary hospitalizations. Reducing the number of inappropriate hospital admissions is another promising method of safely reducing hospital costs. However, once low-risk patients are hospitalized, which is inevitable in many hospitals, strategies to streamline their care and to appropriately shorten their length of stay can further reduce healthcare costs.
Category: Respiratory Symptoms
Tags: antimicrobial therapy, congestive heart failure, healthcare costs, hospitalization, pneumonia