Impact of a hospital-acquired/ventilator-associated/healthcare-associated pneumonia practice guideline on outcomes in surgical trauma patients.
BACKGROUND
Evidence-based guidelines for managing nosocomial pneumonia were published in 2005. Subsequently, our surgical critical care service developed and implemented an adaptation of this guideline for use in our surgical trauma intensive care unit (STICU). This study examined outcomes for two STICU cohorts treated for pneumonia before and after guideline implementation.


METHODS
A total of 130 charts were evaluated. The guideline cohort (GC) consisted of 65 patients with pneumonia managed by the surgical critical care service. These patients were prospectively identified for inclusion if they met specified clinical criteria for pneumonia diagnosis. The historical control cohort was identified retrospectively using ICD-9 coding. The primary outcome measure was ICU length of stay (LOS). Secondary outcome measures included overall LOS, mechanical ventilation days, mortality, and total cost of admission. The study was designed to have 80% power to detect a 1-day decrease in mean ICU LOS in a multivariable regression analysis. Descriptive differences were compared using two-sample t tests for continuous variables and chi for categorical variables.


RESULTS
Baseline characteristics were not significantly different between cohorts. The multivariable regression analysis indicated a mean decrease of 4.6 days, 9.5 days, and 3.9 days for ICU LOS, overall LOS, and mechanical ventilation days, respectively, in the GC, with an expected mean cost reduction per admission of $23,322 (all significant at p <or= 0.0001). There was a 5% difference in hospital mortality in favor of the GC, but this difference was not statistically significant.


CONCLUSIONS
The STICU pneumonia practice guideline significantly improved outcomes and cost of care.
Worrall
Cathy L
CL
Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy--MUSC campus, Charleston, SC, USA. worrallc@sccp.sc.edu
Anger
Brian P
BP
Simpson
Kit N
KN
Leon
Stuart M
SM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000601:surgery*; D055815:Young Adult