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Utility of follow-up recommendations for patients discharged with community-acquired pneumonia

Published online by Cambridge University Press:  21 May 2015

Sam G. Campbell ,
Daphne D. Murray ,
David G. Urquhart ,
David M. Maxwell ,
Stacey Ann Ackroyd-Stolarz ,
Suzanne M. Varley-Doyle ,
Mabel D. Ells  and
Ammar Hawass
Sam G. Campbell*
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
Daphne D. Murray
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
David G. Urquhart
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
David M. Maxwell
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
Stacey Ann Ackroyd-Stolarz
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
Suzanne M. Varley-Doyle
Affiliation:
Discharge Planning Service, Department of Emergency Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS
Mabel D. Ells
Affiliation:
Discharge Planning Service, Department of Emergency Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS
Ammar Hawass
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
*
Department of Emergency Medicine, Queen Elizabeth II HSC, 3021–1796 Summer St., Halifax NS B3H 3A7; fax 902 473 3617, [email protected]

Abstract

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Introduction:

The joint Canadian Infectious Diseases Society and Canadian Thoracic Society guidelines for community-acquired pneumonia (CAP) recommend 48–72 hour telephone follow-up of patients discharged from the emergency department (ED). The guidelines provide no evidence supporting this practice, and neither the clinical utility nor the effectiveness of such recommendations has been assessed. Our objective was to assess the utility of a 48–72 hour telephone follow-up protocol for patients discharged from the ED with CAP.

Methods:

This was a retrospective chart audit covering a 2-year period (Jan. 3, 1999 to Jan. 3, 2001) after the introduction of a clinical practice guideline (CPG) that included routine 48–72 hour telephone follow-up of patients discharged from the ED with CAP. Eligible patients were identified in the ED database, rates of referral for telephone follow-up were recorded, and 30-day outcomes (death and readmission) for patients referred versus not referred were compared.

Results:

During the study period, 867 patients were identified as being eligible for the study. The mean age was 55.7 years (range 16–98 yr), and mean pneumonia severity index (PSI) was 68.9 (range 6–187). Despite the CPG, only 148 patients (17.1%) were referred for telephone follow-up. Age, demographics, comorbidity, clinical status and pneumonia severity were similar for referred and non-referred patients. Thirty-day death (2.5%) and readmission rates (3%) were strongly related to PSI score, but did not differ significantly in the 2 comparison groups.

Conclusions:

In this setting, physicians were poorly compliant with a routine telephone follow-up protocol. The likelihood of referral for follow-up did not correlate with pneumonia severity, and follow-up referral did not appear to affect patient outcome. These findings do not support recommendations for routine early follow-up mechanisms beyond those already existing in the community.

Keywords

pneumoniaoutpatientfollow-upclinical practice guideline
Type
EM Advances • Innovations En MU
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 2 , March 2004 , pp. 97 - 103
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

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