Does early review by a respiratory physician lead to a shorter length of stay for patients with non-severe community-acquired pneumonia?
BACKGROUND
The aim of this study was to evaluate whether patients with non-severe community-acquired pneumonia (CAP) have a shorter length of stay (LOS) when initially seen by a respiratory physician compared with a non-respiratory physician.


METHODS
At Nottingham City Hospital, following nurse triage, acute medical patients who are not severely ill are admitted to the consultant-led emergency short stay unit (ESSU). Records of patients seen on ESSU between January 2004 and December 2007 with a clinical discharge code relating to CAP were retrospectively examined. Patients with a diagnosis of cellulitis over the same time period were used as controls. Patients were grouped depending on whether they were seen on their first post-take ward round by a respiratory consultant physician (group A), non-respiratory consultant physician (group B) or on a Saturday or Sunday (group C).


RESULTS
Following exclusions, 426 patients with CAP and 935 patients with cellulitis were analysed. The median LOS for patients with CAP in group A was 1.74 days (n = 123, interquartile range (IQR) 0.97-4.09) compared with 3.03 days for patients in group B (n = 174, IQR 1.12-6.23; p<0.01). There was a larger percentage of discharges within 24 h of consultant review in group A (43.1%) compared with group B (31.9%), although this was not statistically significant (p = 0.18). There was no statistically significant difference between groups A and B with cellulitis in LOS or percentage discharged within 24 h of first consultant review.


CONCLUSIONS
Patients with non-severe CAP have a shorter hospital LOS when initially seen by a respiratory compared with a non-respiratory physician.
Bewick
T
T
Nottingham City Hospital, 55 Stratford Road, West Bridgford, Nottingham, UK. thomasbewick@doctors.org.uk
Cooper
V J
VJ
Lim
W S
WS
D002908:Chronic Disease; D017714:Community-Acquired Infections / Q000628:therapy; D003253:Consultants; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission; D011014:Pneumonia / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011364:Professional Practice; D015272:Pulmonary Medicine / Q000592:standards*; D011787:Quality of Health Care; D000078329:Workforce