title: Getting physicians to make "the switch": the role of clinical guidelines in the management of community-acquired pneumonia.
abstract: The authors sought to assess physician awareness and usage of American Thoracic Society guidelines for early conversion from intravenous to oral antibiotics ("switch therapy") in those with community-acquired pneumonia (CAP). We then determined if adoption of a CAP guideline would improve either. Patients (N = 510) hospitalized with CAP from June 2002 to May 2003 were identified retrospectively, and chart reviews were done on a random sample (130 [25%]) of these. Physicians were surveyed before and after guideline adoption. Community-acquired pneumonia guideline implementation increased physician awareness of American Thoracic Society recommendations (5% to 40%) and use of switch therapy (60% to 86%). Such use resulted in decreased overall length of stay from 3.6 to 2.4 days (P < .05) and from 2.91 to 2.41 days (P < .05) among early-switch candidates. Early-switch therapy was not optimally used prior to implementation of this CAP guideline. Adoption of the guideline increased awareness and reduced length of stay among inpatients with CAP.
authors.affiliation: Department of Medicine at the University of Cincinnati College of Medicine, Ohio, USA.
authors.forename: Jared T
authors.initials: JT
authors.lastname: Hagaman
authors.forename: Peter
authors.initials: P
authors.lastname: Yurkowski
authors.forename: Alexander
authors.initials: A
authors.lastname: Trott
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Rouan
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001364:Awareness; D017714:Community-Acquired Infections / Q000188:drug therapy*; D019983:Guideline Adherence; D006801:Humans; D007267:Injections; D007902:Length of Stay; D009820:Ohio; D011014:Pneumonia / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents