Effect of a 3-Step Critical Pathway to Reduce Duration of Intravenous Antibiotic Therapy and Length of Stay in Community-Acquired Pneumonia

Abstract

isrctn.org Identifier: ISRCTN17875607.

Lessons learned from 2 decades of CAP therapy data: ways to improve patient management

“…Criteria for switching to oral therapy include: (I) respiratory rate <25 breaths/minute; (II) oxygen saturation >90% or arterial oxygen partial pressure >55 mmHg; (III) hemodynamic stability; (IV) greater than 1 °C decrease in temperature in patients with fever; (V) absence of mental confusion; and (VI) ability to tolerate oral medications. By using such objective criteria, investigators were able to reduce hospital length of stay by almost 2 days, confirming other studies showing the benefit of using objective criteria to guide both the switch from intravenous to oral antibiotics (19,20), as well as the discharge decision (21,22). However, to optimize this transition from intravenous to oral therapy, a guideline itself is not sufficient and results are best when an implementation strategy for switch therapy is present (23).…”

Cost-Effectiveness of Procalcitonin-Guided Antibiotic Use in Community Acquired Pneumonia

“…21 Available randomized trials of procalcitonin protocols in CAP patients lack comparisons with the use of other evidence-based guidelines. [26][27][28][29] It is unclear whether these guidelines were followed in procalcitonin protocol trials' control groups, but future studies should consider adding trial arms where these comparisons could occur. In addition, trials of varying antibiotic duration have shown, in many cases, that shorter antibiotic duration in CAP can be considered.…”

Making Hospitals Safer for Older Adults: Updating Quality Metrics by Understanding Hospital-Acquired Delirium and Its Link to Falls

“…18 Length of stay has been shown to improve with early and progressive mobilization. 19,20 Poor mobilization during hospitalization is associated with poor functional outcomes in older adults. Immobility is an established risk factor for delirium, and lower extremity weakness is an established risk factor for falls in the community.…”