Pneumonia Mortality Decreased From Use of ePNa Clinical Support Tool in the ED

pneumonia
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How effective is the ePNa, an electronic clinical decision-making support tool, when used in patients with pneumonia in the ED?

The deployment of an electronic clinical decision support tool for patients with pneumonia (ePNa) in the emergency room was associated with improved care and a 38% reduction in severity-adjusted all-cause 30-day mortality, according to a study published in American Journal of Respiratory and Critical Care Medicine.  

Study researches at Intermountain Healthcare in Utah sought address the challenges inherent in caring for patients with pneumonia admitted to the emergency department (ED). To determine effects on patient outcomes from use of the ePNa, researchers conducted a pragmatic, stepped-wedge, cluster-controlled trial which deployed the ePNa at 2-month intervals into 16 community hospitals (ClincalTrials.gov Identifier: NCT03358342).

A total of 6848 adult ED patients with pneumonia over 3 years met inclusion criteria for the study. Of these, 4536 were treated before deployment of the ePNa and 2312 patients were treated after deployment. The median age of patients was 67 years (interquartile range 50 to 79), 48% were female, and 64.8% were admitted to hospital. The ePNa was utilized in 67% of eligible patients.

Study researchers found the unadjusted mortality before deployment of the ePNa was 8.6% vs 4.8% after deployment. A mixed-effects logistic regression model, adjusting for severity of illness with hospital cluster as the random effect, revealed an adjusted odds ratio of 0.62 (95% CI, 0.49-0.79; P <.001) for 30-day all-cause mortality after deployment. When evaluating all 6 hospital clusters studied, lower mortality was consistent among the patients (0.63; SD 0.79, ICC 0.13), with lowest mortality seen in patients admitted to the intensive care unit (OR 0.32; CI, 0.14-0.77; P =.01).

Antibiotic prescribing concordant with ePNa was increased from 83.5% to 90.2% (P <.001) and mean time from ED admission to first antibiotic decreased from 159.4 (CI, 156.9-161.9) minutes to 150.9 minutes (CI, 144.1-157.8) after deployment (P <.001). Outpatient disposition from the ED increased from 29.2% to 46.9% and 7-day secondary hospital admissions were unchanged.

Study limitations included the inability to generalize results outside of the single health care system and region of the US where the trial was performed.

According to researchers, their study’s “helps validate the 2007 and 2019 American Thoracic Society and Infectious Diseases Society of America pneumonia treatment guidelines on which ePNa logic is based and demonstrates the impact of real-time clinical decision support integrated into standard workflows.”

Disclosure: This research was supported by Intermountain Office of Research. Please see the original reference for a full list of disclosures.

Reference

Dean NC, Vines CG, Carr JR, et al. A pragmatic stepped-wedge, cluster-controlled trial of real-time pneumonia clinical decision support. Am J Respir Crit Care Med. Published online March 8, 2022. doi:10.1164/rccm.202109-2092OC