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2015 HSR&D/QUERI National Conference Abstract

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3078 — ectronic Medical Record Based Intervention To Reduce Length Of Stay For Veterans Hospitalized With Pneumonia

Mortensen EM, VA North Texas Health Care System; Bollinger M, South Texas Veterans Health Care System; Fine MJ, Center for Health Equity Research and Promotion;

Objectives:
Pneumonia is the second leading cause of hospitalization in the United States with over 20,000 hospitalization each year in the Veterans Health Administration (VA). Although there has been considerable focus on improving pneumonia-related process of care measures, such as use of guideline concordant antibiotics, there has been much less attention paid to reducing length of hospital stay. Therefore we conducted a pre-post intervention trial of a electronic medial record (EMR) based clinical reminder to identify when patients with pneumonia were clinically stable and ready for conversion from IV to oral antibiotics.

Methods:
We conducted this study at a single VA hospital. We developed an EMR-based inpatient clinical reminder to assist physicians with appropriate conversion from IV to oral antibiotics and that encouraged discharge on the same day unless there were other social problems or unstable comorbid conditions. We implemented this reminder with academic detailing on February 1, 2011. We then compared patients hospitalized in April/May 2010 (pre) to patients hospitalized in April/May 2011 (post).

Results:
There were 66 patients in the pre-intervention period and 63 patients in the post-intervention period. There were no statistically significant differences in characteristics between the pre- and post-intervention groups. Overall, mean age was 69.7 years, 96% were male, and 29% were in the ICU during part of their stay. Regarding pneumonia severity index, 28% were classes I-III, 46% were class IV, and 26% were class V. Mortality within 30-days was 3.0% in the pre-intervention and 3.2% in the post-intervention groups (p = 0.96). Length of hospital stay pre-implementation was 7.3 days and post-implementation was 5.4 days (p = 0.05).

Implications:
Implementing an EMR-based reminder was associated with a significantly reduced length of hospital stay without significantly increasing mortality at a single VA medical center. Appropriately reducing length of hospital stay for pneumonia has been previously demonstrated to be associated with reduced costs, and may potentially be associated with improved patient safety. Additional research is needed to determine if this reminder can be successfully implemented in other hospitals.

Impacts:
Introduction of this EMR-based reminder, pending further research, could reduce length of stay at VA hospitals for patients hospitalized with pneumonia in a safe manner.