Intervention to discontinue parenteral antimicrobial therapy in patients hospitalized with pulmonary infections: effect on shortening patient stay.
OBJECTIVE
Current efforts to contain anti-microbial costs in hospitals are based on restricting drugs. We explored the effects of unsolicited case-specific recommendations to physicians to discontinue parenteral antimicrobial therapy in medically stable patients with pneumonia, in order to shorten hospital length of stay.


METHODS
A nurse-interventionist, working as an emissary of an appropriate committee in 3 nonteaching community hospitals, presented randomly assigned physicians with nonconfrontational suggestions to substitute comparable oral antimicrobials for parenteral antimicrobials. Blinded observers evaluated in-hospital and 30-day postdischarge courses of patients of physicians who had been contacted by the nurse (cases) and those who had not (controls).


RESULTS
Eighty-two patient episodes (47 physicians) met study criteria. There were 53 cases and 29 controls. In 42 of 53 (79%) case episodes, physicians discontinued parenteral antimicrobials; patients' mean length of stay was 2.4 days less than for 29 control episodes (estimated cost savings was $884/patient). In 11 (21%) episodes, case physicians continued parenteral therapy; patients' mean length of stay was 1.9 days longer than for controls (estimated cost excess was $704/patient). Education, training and practice characteristics were comparable in physician groups. Severity of illness indicators and postdischarge outcomes were comparable in patient groups.


CONCLUSIONS
The major cost-saving potential for shifting from parenteral to oral antimicrobial therapy is shortened length of stay. Timely information about alternative drug therapies, offered on a patient-specific basis, appears to modify the treating behavior of physicians. The program as currently conducted is cost-effective, with an estimated net savings of $50,000 per 100 interventions.
Ehrenkranz
N J
NJ
Florida Consortium for Infection Control, South Miami.
Nerenberg
D E
DE
Shultz
J M
JM
Slater
K C
KC
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D017046:Cost Savings / Q000379:methods; D004469:Economics, Hospital; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D007902:Length of Stay / Q000191:economics*; D008297:Male; D010820:Physicians / Q000523:psychology; D011014:Pneumonia / Q000188:drug therapy* / Q000191:economics; D011897:Random Allocation
D000900:Anti-Bacterial Agents