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Three-step critical pathway reduced length of stay in patients with CAP
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A three-step critical pathway that included early mobilization of patients hospitalized with community-acquired pneumonia reduced the duration of intravenous antibiotic therapy and the length of hospital stay, according to study results from Spain.
The three-step critical pathway included objective criteria to switch from IV antibiotics to oral antibiotics and used predefined criteria to decide on hospital discharge.
“In an era of increasing competition in medical care, institutions have embraced critical pathways as a strategy for decreasing cost and improving health care quality,” the researchers wrote. “Nevertheless, evidence from prospective controlled trials to evaluate the effects of critical pathways for community-acquired pneumonia is scarce.”
Researchers from the Hospital Universitari de Bellvitge, University of Barcelona, conducted the prospective randomized trial from 2005 to 2007. The study included 401 adults hospitalized for community-acquired pneumonia (CAP). They were randomly assigned to the three-step critical pathway or to usual care. Primary outcome measure was length of hospital stay.
The median length of stay was 3.9 days among those assigned to the three-step critical pathway group vs. 6 days among those assigned to the usual care group (P<.001). The median duration of IV antibiotic therapy was 2 days in the three-step group compared with 4 days in the usual care group (P<.001). More patients in the usual care group experienced adverse drug reactions: 15.9% vs. 4.5% in the three-step group (P<.001).
“In an era of cost containment and resource constraints in health care systems, cost-effective health care delivery is of paramount importance,” the researchers wrote. “Our finding that the application of a three-step pathway reduced the length of stay by 2 days compared with usual care may have significant economic implications.”
References:
Carratalà J. Arch Intern Med. 2012;doi:10.1001/archinternmed.2012.1690.
Disclosures:
The researchers report no relevant financial disclosures.