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Three- step approach reduced hospital stay for people with CA pneumonia
A three-step clinical pathway reduced the time to hospital discharge for people with community- acquired pneumonia. The treatment approach also reduced the duration of intravenous antibiotic therapy.
Researchers from two hospitals in Barcelona conducted a randomized, controlled trial involving patients with community-acquired pneumonia. There were 200 patients in the treatment arm who were managed using the three-step clinical pathway. There were 201 patients in the control arm who were managed using conventional methods. The study was conducted between May 2005 and December 2007.
The primary end point was length of hospital stay. Secondary endpoints included the duration of IV antibiotic therapy, adverse events, need for hospital readmission and overall mortality within a 30-day period.
The first of the three steps in the clinical pathway was early mobilization, which the researchers defined as sitting up in bed or walking for 20 minutes during the first 24 hours of hospitalization. The second step was early switch to oral antibiotic therapy. Other components of the second step included temperature lower than 37.8 degrees Celsius, improvement or resolution of symptoms, the ability to take food and hemodynamic stability. The third step was defined as hospital discharge.
Patients in the clinical pathway group had an average hospital stay of 96 hours and received IV antibiotics for an average of 48 hours. Patients in the control group stayed in the hospital an average of 150 hours and received IV antibiotics for an average of 96 hours.
There was a higher rate of adverse events in patients receiving conventional treatment. The researchers observed similar rates of hospital readmission and mortality in both groups.
Presented at: ICAAC/IDSA joint meeting. Oct. 25-28, 2008. Washington, DC.