Electronic surveillance of hospital pneumonia comparable to manual surveillance
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Key takeaways:
- Electronic non-ventilator-associated hospital-acquired pneumonia surveillance was “moderately” comparable with manual surveillance criteria.
- A claims-based definition correlated poorly.
The electronic surveillance definition for non-ventilator-associated hospital-acquired pneumonia had moderate correlation with the existing manual surveillance definition, suggesting electronic surveillance could be a “more practical” strategy.
“Non-ventilator-associated hospital-acquired pneumonia (NV-HAP) is a common hospital-acquired infection with high morbidity and mortality,” Sarah E. Stern, MD, doctor of medicine at the Intermountain Health LDS Hospital, told Healio. “Unlike other common hospital-acquired infections, we lack robust NV-HAP surveillance and prevention efforts.”
This, she said, stems from the “highly variable and often subjective” clinical diagnosis of pneumonia.
Through a retrospective review, Stern and colleagues aimed to compare the reliability of an electronic surveillance definition with other existing NV-HAP definitions. Stern said doing so could allow for more “efficient, large-scale examination of surveillance and quality improvement efforts.”
According to the study, the researchers applied an electronic surveillance definition for NV-HAP to all adults admitted to Veterans’ Affairs hospitals between Jan. 1, 2015, and Nov. 30, 2020.
They then randomly selected 250 hospitalizations meeting NV-HAP surveillance criteria for independent review by two clinicians and calculated the percent of hospitalizations with either clinical deterioration, CDC National Healthcare Safety Network (CDC-NHSN) criteria, NV-HAP according to a reviewer, NV-HAP according to a treating clinician, pneumonia diagnosis in discharge summary and discharge diagnosis codes for HAP.
In total, 14,023 of more than 3 million hospitalizations met NV-HAP electronic surveillance criteria. Among the cases reviewed, 98% had a confirmed clinical deterioration, 67% met CDC-NHSN criteria, 71% had NV-HAP according to a reviewer, 60% had NV-HAP according to a treating clinician, 49% had a discharge summary diagnosis of pneumonia and 82% had NV-HAP according to any definition according to at least one reviewer.
The study also showed that agreement between two clinicians was reported among 75% of hospitalization for CDC-NHSN criteria and 78% for reviewer diagnosis of NV-HAP.
Stern explained these data show that the electronic surveillance definition has moderate correlation with the existing manual surveillance definition. She added that, in contrast, a claims-based definition correlated “poorly” with the electronic and manual surveillance definitions.
“While no surveillance approach for NV-HAP is perfect, electronic surveillance using readily available clinical data may provide a more practical strategy to increase the scale, efficiency, and reliability of NV-HAP surveillance and quality improvement efforts with similar accuracy compared to manual assessments,” Stern said.
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