Identification of Low-Risk Hospitalized Patients With Pneumonia
Community-acquired pneumonia is responsible for more than 1 million hospital admissions annually in the United States. In 1985, the overall costs of caring for patients with lower respiratory tract infections exceeded $15 billion, and today’s costs are even greater. Moreover, a recent study of 12 hospitals demonstrated that approximately 24 percent of hospitalized patients who died of pneumonia may have suffered potentially preventable deaths. These data demonstrate the tremendous opportunity to improve the quality of care and reduce the cost of hospitalization for pneumonia patients.
Although much has been written about the management of patients with serious community-acquired pneumonia, little information is available to guide physicians regarding the appropriate duration of parenteral antimicrobial therapy or the medically necessary length of stay. Currently, some decisions on the most appropriate timing for converting pneumonia patients from parenteral to oral antimicrobial therapy often are made by physicians arbitrarily and with uncertainty in detail asthma inhalers online. This uncertainty can be illustrated by the wide and unexplainable variations in lengths of stay for hospitalized patients with pneumonia in different communities, in different hospitals, and even in different wards at the same hospital. While some variation in clinical practice is unavoidable, collective clinical information and outcome data could potentially improve clinical decisionmaking regarding the most appropriate length of stay.
Several recently published clinical trials have shown that some patients with pneumonia can be safely treated with oral antimicrobial therapy early in their hospital stay. In one of these studies, the investigators stated that they had initially “approached the use of an exclusively oral regimen with some trepidation. Criteria for selecting patients who are suitable for early conversion often are implicitly rather than explicitly derived, which could deter physicians from using oral antimicrobials at institutions with little or no experience in this area. The accurate identification of patients with pneumonia whose conditions have stabilized and are at very low risk of sustaining complications may facilitate more widespread acceptance of early oral antimicrobial therapy for hospitalized patients with pneumonia, and thereby lead to less costly but still effective medical care.
We studied a practice guideline that identified hospitalized patients with pneumonia who were at low risk for inhospital medical complications. This guideline could be used to facilitate early conversion from parenteral to oral antimicrobial therapy and early hospital discharge. This guideline, if proven safe and effective in a future controlled trial, could ultimately improve the quality and efficiency of medical care for hospitalized patients with pneumonia.
Category: Respiratory Symptoms
Tags: antimicrobial therapy, congestive heart failure, healthcare costs, hospitalization, pneumonia