Interventions to improve emergency-department management of community-acquired pneumonia

Julián Jiménez A, Parejo Miguez R, Cuena Boy R, Palomo De Los Reyes MJ, Laín Terés N, Lozano Ancín A

Objectives: To determine the impact of emergency-department interventions based on

clinical practice guidelines for treating community-acquired pneumonia by analyzing

and comparing management decisions (discharge vs admission; adequacy and timing of

antibiotic treatment; additional tests ordered), results over time (until patients condition

stabilized, duration of hospital stay, emergency department revisits), and mortality

(before and after interventions and up to 5 years).

Methods: Prospective, pre and postintervention study of cases between January 1,

2008, and July 31, 2012, in 4 phases (2 periods before introduction of interventions and

2 periods afterwards).

Results: In the patient groups just after introduction of the guidelines-based

interventions and at the end of the study, time until the patient was stabilized decreased

(by 0.54 days, P<.001), and hospital stay was shorter (by 2.25 days, P<.001). Mortality also fell: in-hospital mortality decreased from 20% to 4.3% (P<.001), and 30-day mortality decreased from 15% to 5.5%, P=.003). Early, adequate use of antibiotics increased, and the total time on antibiotics decreased (by 2.25 days); time on intravenous antibiotics also decreased (by 1.96 days) (all comparisons, P<.001). The pneumonia severity index (PSI) and biomarkers were helpful for making decisions to admit or discharge patients (P<.001). Conclusion: After implementation of clinical practice guidelines and use of the PSI, the emergency care of patients with community-acquired pneumonia improved.

Cuena Boy R, Julián Jiménez A, Laín Terés N, Lozano Ancín A, Palomo De Los Reyes MJ, Parejo Miguez R