OBJECTIVES: To determine the impact of implementing clinical practice guidelines (CPGs) in the treatment of community-acquired pneumonia (CAP) in the emergency department (ED) by analyzing case management decisions (admission or discharge, appropriateness and timeliness of antibiotic therapy, complementary tests) and the consequent results (clinical stabilization time, length of hospital stay, re-admission to ED and mortality). METHODS: A prospective, observational, descriptive, comparative study carried out from 1st January 2008 to 1st August 2009 in two phases: before and after the implementation of the "Management of CAP in ED" SEMES-SEPAR (Spanish Society of Emergency Medicine - Spanish Society of Pneumology and Thoracic Surgery) clinical practice guidelines from 2008. Two hundred adult patients treated in the ED with a diagnosis of CAP were included in the study, both in the pre-intervention and post-intervention groups. RESULTS: The application of the guidelines increased the administration of early and appropriate antibiotic therapy (P<.001) and shortened both the total antibiotic therapy (P<.001) and the intravenous antibiotic therapy (P=.042) times. Time to clinical stabilization (P=.027), length of hospital stay (1.14 days, P=.01), intra-hospital mortality (P=.004) and total 30-day mortality (P=.044) were all reduced. Assessment with the Pneumonia Severity Index (PSI) and biomarkers aided in appropriate decision-making concerning admission/discharge (P<.001). CONCLUSIONS: The implementation of the SEMES-SEPAR 2008 guidelines, along with the use of PSI and biomarkers, significantly improved the entire treatment process of CAP. This benefitted both patients and the system by reducing mortality and improving the results of other patient management factors.
OBJECTIVES: To determine the impact of implementing clinical practice guidelines (CPGs) in the treatment of community-acquired pneumonia (CAP) in the emergency department (ED) by analyzing case management decisions (admission or discharge, appropriateness and timeliness of antibiotic therapy, complementary tests) and the consequent results (clinical stabilization time, length of hospital stay, re-admission to ED and mortality). METHODS: A prospective, observational, descriptive, comparative study carried out from 1st January 2008 to 1st August 2009 in two phases: before and after the implementation of the "Management of CAP in ED" SEMES-SEPAR (Spanish Society of Emergency Medicine - Spanish Society of Pneumology and Thoracic Surgery) clinical practice guidelines from 2008. Two hundred adult patients treated in the ED with a diagnosis of CAP were included in the study, both in the pre-intervention and post-intervention groups. RESULTS: The application of the guidelines increased the administration of early and appropriate antibiotic therapy (P<.001) and shortened both the total antibiotic therapy (P<.001) and the intravenous antibiotic therapy (P=.042) times. Time to clinical stabilization (P=.027), length of hospital stay (1.14 days, P=.01), intra-hospital mortality (P=.004) and total 30-day mortality (P=.044) were all reduced. Assessment with the Pneumonia Severity Index (PSI) and biomarkers aided in appropriate decision-making concerning admission/discharge (P<.001). CONCLUSIONS: The implementation of the SEMES-SEPAR 2008 guidelines, along with the use of PSI and biomarkers, significantly improved the entire treatment process of CAP. This benefitted both patients and the system by reducing mortality and improving the results of other patient management factors.
Authors: Scott R Cutro; Robert Holzman; Yanina Dubrovskaya; Xian Jie Cindy Chen; Tania Ahuja; Marco R Scipione; Donald Chen; John Papadopoulos; Michael S Phillips; Sapna A Mehta Journal: Antimicrob Agents Chemother Date: 2014-05-27 Impact factor: 5.191
Authors: Jesús López-Alcalde; Ricardo Rodriguez-Barrientos; Jesús Redondo-Sánchez; Javier Muñoz-Gutiérrez; José María Molero García; Carmen Rodríguez-Fernández; Julio Heras-Mosteiro; Jaime Marin-Cañada; Jose Casanova-Colominas; Amaya Azcoaga-Lorenzo; Virginia Hernandez Santiago; Manuel Gómez-García Journal: Cochrane Database Syst Rev Date: 2018-09-06
Authors: Joshua P Metlay; Grant W Waterer; Ann C Long; Antonio Anzueto; Jan Brozek; Kristina Crothers; Laura A Cooley; Nathan C Dean; Michael J Fine; Scott A Flanders; Marie R Griffin; Mark L Metersky; Daniel M Musher; Marcos I Restrepo; Cynthia G Whitney Journal: Am J Respir Crit Care Med Date: 2019-10-01 Impact factor: 21.405
Authors: A Julián-Jiménez; I Adán Valero; A Beteta López; L M Cano Martín; O Fernández Rodríguez; R Rubio Díaz; M A Sepúlveda Berrocal; J González Del Castillo; F J Candel González Journal: Rev Esp Quimioter Date: 2018-04-05 Impact factor: 1.553