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Arch Intern Med. 1997 Jan 13;157(1):47-56.
Comment in: Arch Intern Med. 1997
Jan 13;157(1):15-6.
The hospital discharge decision for
patients with community-acquired pneumonia. Results from the
Pneumonia Patient Outcomes Research Team cohort study.
Fine MJ, Medsger AR, Stone RA, Marrie TJ,
Coley CM, Singer DE, Akkad H, Hough LJ, Lang W, Ricci EM,
Polenik DM, Kapoor WN.
BACKGROUND: The hospital discharge
decision directly influences the length of stay in patients with
community-acquired pneumonia, yet no information exists on how
physicians make this decision. OBJECTIVES: To identify the
factors physicians considered the factors responsible for
extending length of hospital stay in clinically stable patients,
and the outpatient medical services that would allow earlier
hospital discharge for patients with community-acquired
pneumonia. METHODS: Physicians responsible for the hospital
discharge decision of patients with community-acquired pneumonia
were asked to identify the factors responsible for extending
stay in patients hospitalized beyond stability, and the medical
services that could have allowed earlier hospital discharge to
occur. RESULTS: For the 418 eligible patients with
community-acquired pneumonia identified during the study, 332
questionnaires (79%) were completed by 168 physicians.
Physicians believed 71 patients (22%) were discharged from the
hospital 1 day or more (median, 2.5 days) after reaching
clinical stability. The most common factors rated as being
"very important" in delaying discharge were diagnostic
evaluation or treatment of comorbid illness (56%), completion of
a "standard course" of antimicrobials (15%), and
delays with arrangements for long-term care (14%). Among the 302
patients with available information on both length of hospital
stay and stability at discharge, median length of stay was 7.0
days for the 29 low-risk patients hospitalized beyond reaching
clinical stability and 5.0 days for the remaining 128 low-risk
patients (P < .005); median length of stay was 12.5 days for
the 42 medium- and high-risk patients hospitalized beyond
reaching clinical stability and 8.0 days in the remaining 113
medium- and high-risk patients (P < .001). Frequently cited
medical services that "probably" or
"definitely" would have allowed earlier discharge to
occur included availability of home intravenous antimicrobial
infusion (26%) and home visits by nurses (20%). CONCLUSIONS:
Physicians believed that diagnostic evaluation or treatment of
comorbid illness, completion of a standard course of
antimicrobial therapy, and delays with arrangements for
long-term care delayed hospital discharge in clinically stable
patients. Addressing the efficiency of these aspects of
inpatient medical care, as well as providing home treatment
programs, could decrease the length of hospital stay in patients
with community-acquired pneumonia.
Publication Types: Multicenter Study
PMID: 8996040 [PubMed - indexed for
MEDLINE]
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