BARCELONA — Use of an electronic decision tool that suggests treatment algorithms improved emergency department triage and significantly reduced in-patient pneumonia mortality, researchers said here.
In-patient mortality decreased from 5.7% in 2010 — before use of the electronic tool — to 3.5% in 2012, a relative reduction in mortality of 25% (P=0.02) after adjusting the data to account for severity of illness, reported Barbara Jones, MD, a fellow in pulmonary and critical care medicine at the University of Utah, Salt Lake City.
In a press briefing at the annual meeting of the European Respiratory Society, Jones said that the electronic tool was rolled out in four hospitals in the Intermountain Healthcare system that operates hospitals in Utah and Idaho. In three hospitals where the tool was not used, Jones said that in-patient pneumonia deaths were 7.2% in 2010 and 6.6% in 2012, a nonsignificant difference.
The researchers collected data from 4,758 patients both before and after the implementation of the tool.
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The electronic tool, she said, leverages the use of electronic patient records which have been in use in the Intermountain group since 1995. “Pneumonia is similar to a lot of diseases in that it has a lot of evidence-based medicine within it,” she said. “Despite the availability of widespread guidelines we actually have seen a lot of variability in treatment. Our aim was to use the electronic tool to help in management of patients with pneumonia.”
When used in practice, Jones said the tool screens all patients with chest imaging in the emergency department. It then uses data in the electronic medical records of the patient to estimate pneumonia severity, the need for unit or intensive care unit admission, and it evaluates the risk for resistant pathogens.
“The tool recommends triage, diagnostic testing, and antibiotic selection at the point of care. It is linked to electronic order entry,” she said. “The tool alerts the physician to the likelihood of a pneumonia diagnosis, and if the physician agrees, the tool proceeds with severity assessment. At any point in the assessment, the physician can disagree with the suggestion of the electronic tool. We have not really looked at how often this occurs.”
Jones said her research team is now analyzing the data to determine how deaths are avoided. “We have a couple of theories,” she told MedPage Today. “One is that our pneumonia support tool may be associated with more appropriate triage and may be able to identify sicker patients. We see a lot of triage variation. We have seen significant variation at the doctor level in triage and at the hospital level as well.
“We thought the electronic tool would impact more appropriate triage to either the intensive care unit or regular ward.
“The diagnostic guidelines were published at our hospital in 2007 and they can be difficult for emergency care doctors to remember. But this and the patient’s electronic record is something that the electronic tool can easily pull. So it helps the emergency room physician make recommendations,” she said.
“The electronic tool may also be driving more appropriate antibiotic use. And it also appears important for correct coverage of pathogens.
“We have further work to do but we are excited about what we have seen so far,” she added.
About 60% of the doctors use the support too, Jones said. The hospitals are about to offer the tool across all 22 hospitals in the group.
Date: Sep 12, 2013