Abstract
INTRODUCTION:
To improve pneumonia care, we developed a real-time electronic decision support tool that provides severity assessment and management recommendations in the Emergency Department (ED). We compared pre- and post-implementation outcomes of 4 hospital EDs where the tool was implemented versus 3 usual care hospitals with only paper guideline forms.
METHODS:
We included all ED patients in seven Intermountain-affiliated hospitals in urban Utah, USA, with ICD-9 codes plus radiographic evidence of pneumonia for two study periods: pre-implementation (Dec 1 2009 – Nov 30 2010, N=2394) and post-implementation (Dec 1 2011-Nov 30 2012, N=2583). We measured rates of over-diagnosis (patients with pneumonia diagnoses but negative chest radiography), hospital admission rates, guideline-concordant triage, length of hospital stay, inpatient mortality, and secondary hospitalization rates. We adjusted outcomes for severity using the previously validated “eCURB” mortality predictor.
RESULTS:
Median age was 59 years, with an admission rate of 61% and 30-day mortality rate of 5.9%. Implementation of the tool was associated with a significant increase in guideline-concordant hospitalizations (81% to 85%, p=0.02) and a reduction in severity-adjusted inpatient mortality (Odds Ratio 0.55, p=.02) that were not observed in the usual care group. There was no significant difference in rates of over-diagnosis, hospital admission, guideline-concordant outpatient triage, length of stay, or secondary hospitalization.
DISCUSSION:
Implementation of a real-time electronic decision support tool was associated with an increase in recommendation-concordant triage and a reduction in inpatient mortality.
- © 2013 ERS