Improved treatment of community-acquired pneumonia through tailored interventions: Results from a controlled, multicentre quality improvement project
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Improved treatment of community-acquired pneumonia through tailored interventions : Results from a controlled, multicentre quality improvement project. / Fally, Markus; von Plessen, Christian; Anhøj, Jacob; Benfield, Thomas; Tarp, Britta; Clausen, Lise Notander; Kolte, Lilian; Diernaes, Emma; Molzen, Line; Seerup, Regitze; Israelsen, Simone; Hellesøe, Anne-Marie Blok; Ravn, Pernille.
I: PLoS ONE, Bind 15, Nr. 6, e0234308, 2020.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › fagfællebedømt
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TY - JOUR
T1 - Improved treatment of community-acquired pneumonia through tailored interventions
T2 - Results from a controlled, multicentre quality improvement project
AU - Fally, Markus
AU - von Plessen, Christian
AU - Anhøj, Jacob
AU - Benfield, Thomas
AU - Tarp, Britta
AU - Clausen, Lise Notander
AU - Kolte, Lilian
AU - Diernaes, Emma
AU - Molzen, Line
AU - Seerup, Regitze
AU - Israelsen, Simone
AU - Hellesøe, Anne-Marie Blok
AU - Ravn, Pernille
PY - 2020
Y1 - 2020
N2 - BACKGROUND: Community-acquired pneumonia (CAP) is one of the leading causes of healthcare utilisation and death worldwide. Treatment according to evidence-based clinical guidelines can reduce mortality, antibiotic exposure and length of hospital stay related to CAP.LOCAL PROBLEM: Several studies, including a pilot study from one of our sites, indicate that physicians show a low grade of guideline adherence when managing patients with CAP.METHODS: To improve the guideline-based treatment of patients with CAP admitted to hospital, we designed a quality improvement study. Four process indicators were combined in a CAP care bundle: chest X-ray, CURB-65 severity score, lower respiratory tract samples and antibiotics within 8 hours from admission. After a 4-month baseline period, we applied multiple interventions at three hospitals during 8 months. Progression in our process indicators was measured continuously and compared with a control site without interventions. After the 8-month intervention period, we continued with a 4-month follow-up period to assess the sustainability of the improvements.RESULTS: The care bundle utilisation rate within 8 hours increased from 11% at baseline to 41% in the follow-up period at the intervention sites, whereas it remained below 3% at the control site. The most considerable improvements have been observed regarding documentation of CURB-65 (34% at baseline, 68% at follow-up) and the collection of lower respiratory tract samples (43% at baseline, 63% at follow-up).CONCLUSION: Our study has demonstrated poor adherence to CAP guidelines at all sites at baseline. After implementing multiple tailored interventions, guideline adherence increased substantially. In conclusion, we recommend that CAP guidelines should be actively adapted in order to be followed in a daily routine.
AB - BACKGROUND: Community-acquired pneumonia (CAP) is one of the leading causes of healthcare utilisation and death worldwide. Treatment according to evidence-based clinical guidelines can reduce mortality, antibiotic exposure and length of hospital stay related to CAP.LOCAL PROBLEM: Several studies, including a pilot study from one of our sites, indicate that physicians show a low grade of guideline adherence when managing patients with CAP.METHODS: To improve the guideline-based treatment of patients with CAP admitted to hospital, we designed a quality improvement study. Four process indicators were combined in a CAP care bundle: chest X-ray, CURB-65 severity score, lower respiratory tract samples and antibiotics within 8 hours from admission. After a 4-month baseline period, we applied multiple interventions at three hospitals during 8 months. Progression in our process indicators was measured continuously and compared with a control site without interventions. After the 8-month intervention period, we continued with a 4-month follow-up period to assess the sustainability of the improvements.RESULTS: The care bundle utilisation rate within 8 hours increased from 11% at baseline to 41% in the follow-up period at the intervention sites, whereas it remained below 3% at the control site. The most considerable improvements have been observed regarding documentation of CURB-65 (34% at baseline, 68% at follow-up) and the collection of lower respiratory tract samples (43% at baseline, 63% at follow-up).CONCLUSION: Our study has demonstrated poor adherence to CAP guidelines at all sites at baseline. After implementing multiple tailored interventions, guideline adherence increased substantially. In conclusion, we recommend that CAP guidelines should be actively adapted in order to be followed in a daily routine.
KW - Aged
KW - Aged, 80 and over
KW - Anti-Bacterial Agents/therapeutic use
KW - Community-Acquired Infections/diagnostic imaging
KW - Denmark
KW - Evidence-Based Medicine
KW - Female
KW - Guideline Adherence
KW - Humans
KW - Male
KW - Middle Aged
KW - Patient Care Bundles/standards
KW - Pilot Projects
KW - Pneumonia/diagnostic imaging
KW - Prospective Studies
KW - Quality Improvement
KW - Severity of Illness Index
U2 - 10.1371/journal.pone.0234308
DO - 10.1371/journal.pone.0234308
M3 - Journal article
C2 - 32525882
VL - 15
JO - PLoS ONE
JF - PLoS ONE
SN - 1932-6203
IS - 6
M1 - e0234308
ER -
ID: 257027676