RT Journal Article
SR Electronic
T1 Decreased mortality with rollout of electronic pneumonia clinical decision support across 16 Utah hospital emergency departments
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 4667
DO 10.1183/13993003.congress-2020.4667
VO 56
IS suppl 64
A1 Nathan Dean
A1 Caroline Vines
A1 Jenna Rubin
A1 Brandon Webb
A1 Jason Jacobs
A1 Allison Butler
A1 Jaehoon Lee
A1 Al Jephson
A1 Nathan Jenson
A1 Missy Walker
A1 Jeremy Irvin
A1 Matthew Lungren
A1 Jason Carr
A1 Raj Srivastava
A1 Todd Allen
YR 2020
UL http://erj.ersjournals.com/content/56/suppl_64/4667.abstract
AB Introduction: ePNa open loop, electronic clinical decision support improved mortality and disposition for emergency department (ED) community-acquired pneumonia patients in 4 intervention hospitals vs 3 usual care hospitals (Annals EM 2015 66:511). ePNa provides ED clinicians with support for diagnosis and objective severity measurement, then disposition and antibiotic recommendations based on the DRIP score. We rolled out ePNa across 16 additional Intermountain Healthcare (Utah, USA) Hospitals beginning 2018 in a stepwise implementation trial.Objectives: Evaluate whether ePNa might improve clinical outcomes in a diverse group of non-teaching hospitals.Methods: 7293 ED patients >18 years 2017 to 2019 with complete data were identified electronically by ICD-10 codes; patients without confirmatory chest imaging (CheXED, Stanford AI model) were excluded.Results: Median age was 67 (IQR 52-79) years, 48% female.ePNa: use by clinicians averaged 47.4% after rollout but varied from 10% to 92% by month and hospital. Intention to treat analysis showed 30-day mortality of 5% (146/3101) vs 10% (417/4192) before rollout; outpatient disposition increased from 21% vs 48%. 7-day secondary hospitalization was 1% vs 3% after rollout. 30-day all-cause mortality was significantly lower after severity adjustment (electronicCURB, age, PaO2/FiO2, pleural effusion, HCAP, gender) by logistic regression (OR 0.57, 95% CI 0.46,0.69, p <.001).Conclusions: Rollout of ePNa clinical decision support into 16 hospital ED was associated with decreased mortality and hospital admission among pneumonia patients. We plan further interventions to increase ePNa use by ED clinicians.FootnotesCite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 4667.This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).