Source: Annual Congress 2001 - Community-acquired pneumonia: from diagnosis to discharge
Disease area: Respiratory infections

Abstract

Background: Critical Pathways (CP) are successful in reducing management variation, but not reducing the Length Of Stay (LOS) for Community Acquired Pneumonia (CAP). This study determines factors increasing a patient's LOS beyond the dicharge criteria used by Marrie et al (JAMA 2000; 283:749).
Methods: Patients admitted with CAP and placed on the Pneumonia Pathway were studied. Patient functional status was evaluated using Barthel's Index (BI), the Hierarchical Assessment of Balance and Mobility (HABAM), and the Mini-Mental State Exam (MMSE) when discharge criteria were met. Once met, the patient, a family member, and the attending physician completed a questionnaire to assess factors other than functional status which extend LOS.
Results: Nineteen patients are enrolled, 5 were discharged when criteria were met, 14 had an extended LOS. Age, living arrangements, education, and employment status did not affect LOS. When discharge criteria were met, there were no differences in the average BI (87.3 vs. 89.3; ns), HABAM (20.4 vs. 22.7; ns) and MMSE (27.2 vs. 28.7; ns). When discharge criteria were met, most patients from both groups felt discharge was appropriate (4/5 vs. 9/14; ns). Family agreement with the discharge decision was the best predictor of whether a patient was discharged once criteria were met (100% vs. 45%). The families of patients with an extended LOS cited concerns about lifestyle change to care for the patient and the need for assistance.
Conclusion: Family-based concerns about the care of CAP patients extend the length of hospitalisation. Interventions to improve compliance with these discharge criteria will need to focus on the family.

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Citations should be made in the following way:
M. T. Ma, P. Hernandez, T. J. Marrie, W. D. Patrick (Nova Scotia, Alberta, Canada). Observational study looking at reasons for noncompliance with discharge criteria in a pneumonia pathway. Eur Respir J 2001; 16: Suppl. 31, 3397

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