title: Improved management of community-acquired pneumonia in the emergency department.
abstract: OBJECTIVE
  To determine the impact of implementing clinical practice guidelines (CPGs) in the treatment of community-acquired pneumonia (CAP) in the emergency department (ED) by analyzing case management decisions (admission or discharge, appropriateness and timeliness of antibiotic therapy, complementary tests) and the consequent results (clinical stabilization time, length of hospital stay, re-admission to ED and mortality).
  
  
  METHODS
  A prospective, observational, descriptive, comparative study carried out from 1st January 2008 to 1st August 2009 in two phases: before and after the implementation of the "Management of CAP in ED" SEMES-SEPAR (Spanish Society of Emergency Medicine - Spanish Society of Pneumology and Thoracic Surgery) clinical practice guidelines from 2008. Two hundred adult patients treated in the ED with a diagnosis of CAP were included in the study, both in the pre-intervention and post-intervention groups.
  
  
  RESULTS
  The application of the guidelines increased the administration of early and appropriate antibiotic therapy (P<.001) and shortened both the total antibiotic therapy (P<.001) and the intravenous antibiotic therapy (P=.042) times. Time to clinical stabilization (P=.027), length of hospital stay (1.14 days, P=.01), intra-hospital mortality (P=.004) and total 30-day mortality (P=.044) were all reduced. Assessment with the Pneumonia Severity Index (PSI) and biomarkers aided in appropriate decision-making concerning admission/discharge (P<.001).
  
  
  CONCLUSIONS
  The implementation of the SEMES-SEPAR 2008 guidelines, along with the use of PSI and biomarkers, significantly improved the entire treatment process of CAP. This benefitted both patients and the system by reducing mortality and improving the results of other patient management factors.
authors.affiliation: Servicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, Spain. agustinj@sescam.jccm.es
authors.forename: Agustín
authors.initials: A
authors.lastname: Julián-Jiménez
authors.forename: María José
authors.initials: MJ
authors.lastname: Palomo de los Reyes
authors.forename: Raquel
authors.initials: R
authors.lastname: Parejo Miguez
authors.forename: Natividad
authors.initials: N
authors.lastname: Laín-Terés
authors.forename: Rafael
authors.initials: R
authors.lastname: Cuena-Boy
authors.forename: Agustín
authors.initials: A
authors.lastname: Lozano-Ancín
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D017714:Community-Acquired Infections / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D015897:Comorbidity; D019468:Disease Management; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D018410:Pneumonia, Bacterial / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D012307:Risk Factors; D018401:Sample Size; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013030:Spain / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000458:organization & administration / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein