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Effect of a 3-step critical pathway to reduce duration of intravenous antibiotic therapy and length of stay in community-acquired pneumonia: a randomized controlled trial.
Arch Intern Med. 2012 Jun 25; 172(12):922-8.AI

Abstract

BACKGROUND

The length of hospital stay (LOS) for community-acquired pneumonia (CAP) varies considerably, even though this factor has a major impact on the cost of care. We aimed to determine whether the use of a 3-step critical pathway is safe and effective in reducing duration of intravenous antibiotic therapy and length of stay in hospitalized patients with CAP.

METHODS

We randomly assigned 401 adults who required hospitalization for CAP to follow a 3-step critical pathway including early mobilization and use of objective criteria for switching to oral antibiotic therapy and for deciding on hospital discharge or usual care. The primary end point was LOS. Secondary end points were the duration of intravenous antibiotic therapy, adverse drug reactions, need for readmission, overall case-fatality rate, and patients' satisfaction.

RESULTS

Median LOS was 3.9 days in the 3-step group and 6.0 days in the usual care group (difference, -2.1 days; 95% CI, -2.7 to -1.7; P < .001). Median duration of intravenous antibiotic therapy was 2.0 days in the 3-step group and 4.0 days in the usual care group (difference, -2.0 days; 95% CI, -2.0 to -1.0; P < .001). More patients assigned to usual care experienced adverse drug reactions (4.5% vs 15.9% [difference, -11.4 percentage points; 95% CI, -17.2 to -5.6 percentage points; P < .001]). No significant differences were observed regarding subsequent readmissions, case fatality rate, and patients' satisfaction with care.

CONCLUSIONS

The use of a 3-step critical pathway was safe and effective in reducing the duration of intravenous antibiotic therapy and LOS for CAP and did not adversely affect patient outcomes. Such a strategy will help optimize the process of care of hospitalized patients with CAP, and hospital costs would be reduced.

TRIAL REGISTRATION

isrctn.org Identifier: ISRCTN17875607.

Authors+Show Affiliations

Infectious Disease Service, Bellvitge Institute for Biomedical Research (IDIBELL)-Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet, Barcelona, Spain. jcarratala@ub.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22732747

Citation

Carratalà, Jordi, et al. "Effect of a 3-step Critical Pathway to Reduce Duration of Intravenous Antibiotic Therapy and Length of Stay in Community-acquired Pneumonia: a Randomized Controlled Trial." Archives of Internal Medicine, vol. 172, no. 12, 2012, pp. 922-8.
Carratalà J, Garcia-Vidal C, Ortega L, et al. Effect of a 3-step critical pathway to reduce duration of intravenous antibiotic therapy and length of stay in community-acquired pneumonia: a randomized controlled trial. Arch Intern Med. 2012;172(12):922-8.
Carratalà, J., Garcia-Vidal, C., Ortega, L., Fernández-Sabé, N., Clemente, M., Albero, G., López, M., Castellsagué, X., Dorca, J., Verdaguer, R., Martínez-Montauti, J., Manresa, F., & Gudiol, F. (2012). Effect of a 3-step critical pathway to reduce duration of intravenous antibiotic therapy and length of stay in community-acquired pneumonia: a randomized controlled trial. Archives of Internal Medicine, 172(12), 922-8. https://doi.org/10.1001/archinternmed.2012.1690
Carratalà J, et al. Effect of a 3-step Critical Pathway to Reduce Duration of Intravenous Antibiotic Therapy and Length of Stay in Community-acquired Pneumonia: a Randomized Controlled Trial. Arch Intern Med. 2012 Jun 25;172(12):922-8. PubMed PMID: 22732747.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of a 3-step critical pathway to reduce duration of intravenous antibiotic therapy and length of stay in community-acquired pneumonia: a randomized controlled trial. AU - Carratalà,Jordi, AU - Garcia-Vidal,Carolina, AU - Ortega,Lucía, AU - Fernández-Sabé,Núria, AU - Clemente,Mercedes, AU - Albero,Ginesa, AU - López,Marta, AU - Castellsagué,Xavier, AU - Dorca,Jordi, AU - Verdaguer,Ricard, AU - Martínez-Montauti,Joaquín, AU - Manresa,Frederic, AU - Gudiol,Francesc, PY - 2012/6/27/entrez PY - 2012/6/27/pubmed PY - 2012/9/26/medline SP - 922 EP - 8 JF - Archives of internal medicine JO - Arch Intern Med VL - 172 IS - 12 N2 - BACKGROUND: The length of hospital stay (LOS) for community-acquired pneumonia (CAP) varies considerably, even though this factor has a major impact on the cost of care. We aimed to determine whether the use of a 3-step critical pathway is safe and effective in reducing duration of intravenous antibiotic therapy and length of stay in hospitalized patients with CAP. METHODS: We randomly assigned 401 adults who required hospitalization for CAP to follow a 3-step critical pathway including early mobilization and use of objective criteria for switching to oral antibiotic therapy and for deciding on hospital discharge or usual care. The primary end point was LOS. Secondary end points were the duration of intravenous antibiotic therapy, adverse drug reactions, need for readmission, overall case-fatality rate, and patients' satisfaction. RESULTS: Median LOS was 3.9 days in the 3-step group and 6.0 days in the usual care group (difference, -2.1 days; 95% CI, -2.7 to -1.7; P < .001). Median duration of intravenous antibiotic therapy was 2.0 days in the 3-step group and 4.0 days in the usual care group (difference, -2.0 days; 95% CI, -2.0 to -1.0; P < .001). More patients assigned to usual care experienced adverse drug reactions (4.5% vs 15.9% [difference, -11.4 percentage points; 95% CI, -17.2 to -5.6 percentage points; P < .001]). No significant differences were observed regarding subsequent readmissions, case fatality rate, and patients' satisfaction with care. CONCLUSIONS: The use of a 3-step critical pathway was safe and effective in reducing the duration of intravenous antibiotic therapy and LOS for CAP and did not adversely affect patient outcomes. Such a strategy will help optimize the process of care of hospitalized patients with CAP, and hospital costs would be reduced. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN17875607. SN - 1538-3679 UR - https://www.unboundmedicine.com/medline/citation/22732747/Effect_of_a_3_step_critical_pathway_to_reduce_duration_of_intravenous_antibiotic_therapy_and_length_of_stay_in_community_acquired_pneumonia:_a_randomized_controlled_trial_ DB - PRIME DP - Unbound Medicine ER -