Electronic Decision Support System Improves Outcomes in Patients With Pneumonia

The use of a real-time electronic, open loop, clinical decision support (ePNa) system helped to produce a 38% lower overall mortality rate among patients with pneumonia treated at a community hospital, according to a study published in the American Journal of Respiratory and Critical Care Medicine.

The ePNa system supported best practice care for emergency department (ED) patients with pneumonia by helping to lower intensive care unit (ICU) admission, enabling more appropriate antibiotic use, as well as the reduction in overall mortality at Intermountain Healthcare in Salt Lake City, according to the study.

“Treating pneumonia in emergency departments is challenging, especially in community hospitals that don’t see severe pneumonia as often as urban academic medical centers,” said principal study investigator Nathan Dean, MD, section chief of pulmonary and critical care medicine at Intermountain Medical Center, in a press release.

For the study, investigators used the health system’s ePNa system at 16 of its community hospitals between December 2017 and June 2019. During that timeframe, the 16 hospitals had 6848 pneumonia cases, with ePNa used by a bedside clinician in 67% of eligible patients.

The tool collects patient indicators, such as age, fever, oxygen saturation, laboratory and chest imaging results, and vital signs to help guide care decisions, including appropriate antibiotic therapy, microbiology studies, and care setting recommendations

Use of the tool showed a 38% relative decrease in mortality 30 days after being diagnosed with pneumonia, with the largest drop in mortality among those admitted directly from the ED to the ICU; a 17% spike in outpatient disposition; lower ICU admission without safety concerns; and reduced mean time from ED admission to initiation of the first antibiotic.

The investigators said the findings are consistent with a prior study on the use of ePNa in Intermountain’s larger hospitals. Intermountain was ranked by U.S. News and World Report as high performing in pneumonia care with excellent outcomes during the period in which the study was conducted.

“In giving clinicians a real-time assessment tool that pulls together over 50 factors that can determine how a patient will do with pneumonia, our study found that clinicians were able to make better treatment decisions with this resource,” Dean saidn in the release. “Some of our community hospitals have as little as 20 beds. We wanted to validate the effectiveness of ePNa in very different health care settings.”

Dean noted that the ePNa system made recommendations that supported clinician decisions and helped them to be more structured and consistent in decision-making for the care of patients with pneumonia.

“Even if they don’t follow the recommendation, decision-making is more consistent with best practices,” he said in the release.

Reference

Electronic pneumonia decision support helps reduce mortality by 38% in community hospitals. EurekAlert. [news release]. Accessed March 28, 2022. https://www.eurekalert.org/news-releases/945906