Effect of a 3-Step Critical Pathway to Reduce Duration of Intravenous Antibiotic Therapy and Length of Stay in Community-Acquired Pneumonia A Randomized Controlled Trial
Effect of a 3-Step Critical Pathway to Reduce Duration of Intravenous Antibiotic Therapy and Length of Stay in Community-Acquired Pneumonia A Randomized Controlled Trial
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DOI：
10.1001/archinternmed.2012.1690
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发表时间：
2012-06-25
影响因子：
--
通讯作者：
Gudiol, Francesc
中科院分区：
文献类型：
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作者：
Carratala, Jordi;Garcia-Vidal, Carolina;Gudiol, Francesc
背景：社区获得性肺炎(CAP)的住院时间(LOS)差异很大，尽管这一因素对医疗费用有重大影响。方法：我们随机将401名需要CAP住院治疗的成人随机分为三步关键路径，包括早期动员和客观标准的使用，以决定是否改用口服抗生素治疗以及决定出院或常规护理。主要的终点是洛杉矶。次要终点是静脉注射抗生素治疗的持续时间、药物不良反应、再入院需求、总病死率和患者满意度。结果：三步疗法组和常规护理组的中位LOS分别为3.9天和6.0天(差异，-2.1天；95%可信区间，-2.7~-1.7；P<；.001)。静脉抗生素治疗的中位持续时间，三步组为2.0天，常规护理组为4.0天(差值，-2.0天；95%可信区间-2.0至-1.0；P<；.001)。更多被分配到常规护理的患者出现了不良反应(4.5%比15.9%[差异，-11.4个百分点；95%可信区间，-17.2--5.6个百分点；P<；0.0011])。两组患者的再入院时间、病死率和患者对护理的满意度无显著差异。结论：三步关键路径的使用在减少CAP的静脉抗生素治疗时间和LOS方面是安全和有效的，并且不会对患者的预后产生不利影响。这样的策略将有助于优化CAP住院患者的护理流程，并将降低医院成本。
Background: The length of hospital stay (LOS) for community-acquired pneumonia (CAP) varies considerably, even though this factor has a major impact on the cost of care. We aimed to determine whether the use of a 3-step critical pathway is safe and effective in reducing duration of intravenous antibiotic therapy and length of stay in hospitalized patients with CAP.Methods:We randomly assigned 401 adults who required hospitalization for CAP to follow a 3-step critical pathway including early mobilization and use of objective criteria for switching to oral antibiotic therapy and for deciding on hospital discharge or usual care. The primary end point was LOS. Secondary end points were the duration of intravenous antibiotic therapy, adverse drug reactions, need for readmission, overall case-fatality rate, and patients' satisfaction.Results: Median LOS was 3.9 days in the 3-step group and 6.0 days in the usual care group (difference, -2.1 days; 95% CI, -2.7 to -1.7; P < .001). Median duration of intravenous antibiotic therapy was 2.0 days in the 3-step group and 4.0 days in the usual care group (difference, -2.0 days; 95% CI, -2.0 to -1.0; P < .001). More patients assigned to usual care experienced adverse drug reactions (4.5% vs 15.9% [difference, -11.4 percentage points; 95% CI, -17.2 to -5.6 percentage points; P < .0011). No significant differences were observed regarding subsequent readmissions, case fatality rate, and patients' satisfaction with care.Conclusions: The use of a 3-step critical pathway was safe and effective in reducing the duration of intravenous antibiotic therapy and LOS for CAP and did not adversely affect patient outcomes. Such a strategy will help optimize the process of care of hospitalized patients with CAP, and hospital costs would be reduced.