Assessment of Outpatient Pneumonia Therapy with Return and Admission Rates from the Emergency Department
Abstract
Objectives: Community acquired pneumonia (CAP) is a common reason for emergency department (ED) visits and is associated with high return rates and mortality. Physicians and pharmacists in the ED are responsible for initial diagnosis and therapy initiation. The purpose of this study is to identify adherence to guideline-recommended empiric antibiotic therapy for CAP, assess reasons for nonadherence, and evaluate the impact of incorrect empiric therapy on admission rates.
Methods: This study was performed as a single-center, retrospective, observational chart review and included ED patients with pneumonia. Each patient was reviewed for inclusion and exclusion criteria, appropriateness of therapy according to the 2019 CAP guidelines, and repeat ED visits or admission within 30 days.
Results: 110 patients met inclusion criteria. 12 (10.9%) received correct empiric therapy; the remaining 98 patients (89.1%) classified as incorrect were most often found to have prescription durations longer than recommended (64.3%) or needed additional empiric coverage due to comorbidities (41.8%). Of the 27 patients that returned to the ED, eleven returned for worsening pneumonia, with six admitted. Of the patients admitted for worsening pneumonia, none received appropriate therapy. No statistical significance was found for this data.
Conclusion: Although most empiric treatment regimens were incorrect per the guidelines, there were no differences seen for rates of return ED visits or admissions for any cause or for worsening pneumonia. Though education may be beneficial, higher-powered studies would be needed to determine this impact on patient-centered outcomes of return ED visits and admissions for suboptimal empiric antibiotics for CAP.
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