Which patients with lower respiratory tract infections need inpatient treatment? Perceptions of physicians, nurses, patients and relatives.
BACKGROUND
Despite recommendations for outpatient management, low risk patients with lower respiratory tract infections (LRTIs) are often hospitalized. This survey analyzed perceptions of physicians, nurses, patients and relatives about feasibility of outpatient management and required duration of hospital stay.


METHODS
We performed a prospective, observational questionnaire survey in hospitalized patients with LRTI as part of a multicenter trial. Treating physicians and nurses, patients and their relatives were asked on admission and before discharge about feasibility of outpatient treatment over 5 dimensions (medical, nursing, organizational factors, and patients' and relatives' preferences) using continuous scales.


RESULTS
On admission, 12.6% of physicians, 15.1% of nurses, 18.0% of patients and 5.2% of relatives believed that outpatient treatment would be possible. Before hospital discharge, 31.1% of physicians, 32.2% of nurses, 11.6% of patients and 4.1% of relatives thought that earlier discharge would have been feasible. Medical factors were the most frequently perceived motives for inpatient management. These perceptions were similar in all LRTI subgroups and independent of disease severity and associated expected mortality risks as assessed by the Pneumonia Severity Index (PSI).


CONCLUSIONS
Independent of type and severity of respiratory tract infection, the misperceived high severity and expected mortality and morbidity were the predominant reasons why treating physicians, nurses, patients and their relatives unanimously believed that inpatient management was necessary. Better assessment and communication about true expected medical risks might contribute to a pathway to shorten in-hospital days and to introduce a more risk-targeted and individually tailored allocation of health-care resources.


BACKGROUND
NCT00350987.
Baehni
Claudia
C
Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
Meier
Sabine
S
Spreiter
Pamela
P
Schild
Ursula
U
Regez
Katharina
K
Bossart
Rita
R
Thomann
Robert
R
Falconnier
Claudine
C
Christ-Crain
Mirjam
M
De Geest
Sabina
S
Müller
Beat
B
Schuetz
Philipp
P
D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005190:Family / Q000523:psychology*; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D011014:Pneumonia / Q000401:mortality / Q000523:psychology* / Q000628:therapy*; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000401:mortality / Q000523:psychology / Q000628:therapy; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires