Evaluation of a protocol to optimize duration of pneumonia therapy at hospital discharge.
OBJECTIVE
A protocol to optimize the duration of antimicrobial therapy (DAT) for uncomplicated pneumonia at hospital discharge was evaluated.


METHODS
This retrospective quasiexperimental study was conducted at Boise Veterans Affairs Medical Center from March 2013 through June 2015. Patients were included in the study if they were diagnosed with pneumonia, were hospitalized for more than 24 hours, received antimicrobial treatment within 48 hours of admission, and survived until hospital discharge. The intervention included development of a pneumonia DAT triage algorithm, a process for assessment of the appropriate DAT by pharmacists, and recommendations to providers to limit excessive discharge DATs prescribed. Interrupted time-series analysis was performed to determine the mean monthly DAT per patient and the 30-day readmission rate.


RESULTS
Of the 707 patients discharged with a diagnosis of pneumonia, 560 met the criteria for study inclusion (366 in the preimplementation group and 194 in the postimplementation group). Change in slope of monthly mean DAT per patient postimplementation was significantly reduced (p = 0.03) from the preimplementation slope (p = 0.95), indicating an association between the intervention and mean DAT per patient. The intervention was not associated with the 30-day readmission rate. The mean ± S.D. DAT decreased from 9.5 ± 2.4 days preimplementation to 8.2 ± 2.9 days postimplementation, primarily due to the reduction of outpatient DAT from 5.2 ± 3.0 days preimplementation to 4.2 ± 3.0 days postimplementation.


CONCLUSIONS
A pharmacy-based triage algorithm helped to reduce excessive DATs for patients with pneumonia at hospital discharge without negatively affecting 30-day readmission rates.
Pharmacy Service, Boise Veterans Affairs Medical Center, Boise, ID.|Truven Healthcare Analytics, Greenwood Village, CO.
Christina
C
Caplinger
Pharmacy Service, Boise Veterans Affairs Medical Center, Boise, ID.
Kendall
K
Crane
St. Alphonsus Regional Medical Center, Boise, ID.
Michelle
M
Wilkin
Pharmacy Service, Boise Veterans Affairs Medical Center, Boise, ID.
Jefferson
J
Bohan
Research Service, Boise Veterans Affairs Medical Center, Boise, ID.|Quantified Inc., Boise, ID.
Richard
R
Remington
College of Pharmacy, Idaho State University, Meridian ID karl.madaras-kelly2@va.gov.|Pharmacy Service, Boise, Veterans Affairs Medical Center, Boise, ID. karl.madaras-kelly2@va.gov.
Karl
K
Madaras-Kelly
D000890:Anti-Infective Agents / Q000008:administration & dosage*; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology; D004334:Drug Administration Schedule; D005260:Female; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D065186:Interrupted Time Series Analysis / Q000379:methods / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000592:standards* / Q000639:trends; D011014:Pneumonia / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies
D000890:Anti-Infective Agents
IDSA guidelines; antimicrobial stewardship; pneumonia; therapy duration