title: Which patients with lower respiratory tract infections need inpatient treatment? Perceptions of physicians, nurses, patients and relatives.
abstract: 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.
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Claudia
authors.initials: C
authors.lastname: Baehni
authors.forename: Sabine
authors.initials: S
authors.lastname: Meier
authors.forename: Pamela
authors.initials: P
authors.lastname: Spreiter
authors.forename: Ursula
authors.initials: U
authors.lastname: Schild
authors.forename: Katharina
authors.initials: K
authors.lastname: Regez
authors.forename: Rita
authors.initials: R
authors.lastname: Bossart
authors.forename: Robert
authors.initials: R
authors.lastname: Thomann
authors.forename: Claudine
authors.initials: C
authors.lastname: Falconnier
authors.forename: Mirjam
authors.initials: M
authors.lastname: Christ-Crain
authors.forename: Sabina
authors.initials: S
authors.lastname: De Geest
authors.forename: Beat
authors.initials: B
authors.lastname: Müller
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
mesh_terms: 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