Fernandez, John Michael BSN403 Group 10-A

Prof. De Guzman

Tool Cuts Pneumonia Deaths By 25%

Neil Canavan
September 18, 2013

BARCELONA, Spain A new device dramatically reduces pneumonia deaths and related treatment complications, report researchers. The electronic tool uses existing electronic health records to suggest guideline-based patient management. From appropriate triage to the selection of antibiotics, the device is designed to improve care. "Pneumonia, like many diseases, has a lot of evidence-based medicine to guide treatment decisions," said Barbara Jones, MD, from Intermountain Healthcare in Salt Lake City. "There are a lot of things we know are the right thing to do. However, despite this and the widespread availability of guidelines, we were observing a significant variation in healthcare delivery in our system." Dr. Jones presented the research here at the European Respiratory Society (ERS) 2013 Annual Congress. We implemented the decision-support tool "to start leveraging our existing electronic healthcare record system for use in quality improvement," she explained. The tool was developed to guide decisions related to the management of lung infections. It was rolled out at 4 hospitals that are part of Intermountain Healthcare, an organization with 22 hospitals and 185 clinics throughout Utah and Idaho. Data from 4758 patients treated at the centers were collected before and 1 year after the implementation. "The first thing the tool does is look for all patients with any chest imaging being done in the emergency department," Dr. Jones explained. It then examines the clinical features entered in the electronic healthcare record, estimates the likelihood of a diagnosis of pneumonia, and alerts the physician to that possibility."

If the physician agrees with that assessment doctors are free to disagree with any recommendation the system does a severity assessment and provides triage recommendations for admission to the intensive care unit or medical ward. After this, the potential involvement of resistant pathogens is gauged, and diagnostic tests and treatment options, including antibiotic selection, are suggested. After the initial rollout of the tool, the risk for inpatient death dropped by 25% (P = .02). So what were physicians doing wrong? "Future work will try to find the mechanism of this mortality impact," said Dr. Jones. It is possible that the tool is "associated with an increase in appropriate triage by helping identify sicker patients who need hospitalization. It also may be driving more appropriate antibiotic use." Regardless, the data are compelling enough that the program will be extended to other diseases. "This is a pretty dramatic reduction in mortality," said ERS vice president Peter Barnes, MD. "If this was a new drug, it would be headline news, but because it's a change in patient management, it doesn't get much popular mention. That in itself is an important message we don't necessarily need new drugs, we just need better use of existing drugs." Dr. Barnes focused on one particular component of the decision-support tool: guidance on appropriate antibiotic selection. "This is such a big issue now because of our concerns with antibiotic resistance. This problem is one of the biggest threats to human health going forward, and is more serious than any other disease threat we face," he told Medscape Medical News. Dr. Jones and Dr. Barnes have disclosed no relevant financial relationships. European Respiratory Society (ERS) 2013 Annual Congress: Abstracts 5044. Presented September 10, 2013.

Summary A new device dramatically reduces pneumonia deaths and related treatment complications, report researchers. The electronic tool uses existing electronic health records to suggest guideline-based patient management. From appropriate triage to the selection of antibiotics, the device is designed to improve care. The tool was developed to guide decisions related to the management of lung infections. The first thing the tool does is look for all patients with any chest imaging being done in the emergency department. It then examines the clinical features entered in the electronic healthcare record, estimates the likelihood of a diagnosis of pneumonia, and alerts the physician to that possibility. After this, the potential involvement of resistant pathogens is gauged, and diagnostic tests and treatment options, including antibiotic selection, are suggested.

Reaction It is very important information for me as well as for the clinicians in developing countries where deaths from pneumonia are enormously high. We should explore more to know whether this kind of changed management plan could be used in triages in hospitals of developing countries. More physicians & patients can make a global impact and difference if the tool can be shared globally.

Tool Cuts Pneumonia Deaths By 25%

Neil Canavan September 18, 2013 Barcelona, Spain

A new device dramatically reduces pneumonia deaths and related treatment complications, report researchers. The electronic tool uses existing electronic health records to suggest guideline -based patient management. From appropriate triage to the selection of antibiotics, the device is designed to improve care. "Pneumonia, like many diseases, has a lot of evidence-based medicine to guide treatment decisions. There are a lot of things we know are the right thing to do. However, despite this and the widespread availability of guidelines, we were observing a significant variation in healthcare delivery in our system. We implemented the decision-support tool "to start leveraging our existing electronic healthcare record system for use in quality improvement. The tool was developed to guide decisions related to the management of lung infections. It was rolled out at 4 hospitals that are part of Intermountain Healthcare, an organization with 22 hospitals and 185 clinics throughout Utah and Idaho. Data from 4758 patients treated at the centers were collected before and 1 year after the implementation. The first thing the tool does is look for all patients with any chest imaging being done in the emergency department. It then examines the clinical features entered in the electronic healthcare record, estimates the likelihood of a diagnosis of pneumonia, and alerts the physician to that possibility. If the physician agrees with that assessment doctors are free to disagree with any recommendation the system does a severity assessment and provides triage recommendations for admission to the intensive care unit or medical ward. After this, the

potential involvement of resistant pathogens is gauged, and diagnostic tests and treatment options, including antibiotic selection, are suggested. After the initial rollout of the tool, the risk for inpatient death dropped by 25% (P = .02). Future work will try to find the mechanism of this mortality impact. It is possible that the tool is associated with an increase in appropriate triage by helping identify sicker patients who need hospitalization. It also may be driving more appropriate antibiotic use. Regardless, the data are compelling enough that the program will be extended to other diseases. This is a pretty dramatic reduction in mortality. If this was a new drug, it would be headline news, but because it's a change in patient management, it doesn't get much popular mention. That in itself is an important message we don't necessarily need new drugs, we just need better use of existing drugs. The physicians focused on one particular component of the decision-support tool: guidance on appropriate antibiotic selection. This is such a big issue now because of our concerns with antibiotic resistance. This problem is one of the biggest threats to human health going forward, and is more serious than any other disease threat we face.