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Intervention to Discontinue Parenteral Antimicrobial Therapy in Patients Hospitalized with Pulmonary Infections: Effect on Shortening Patient Stay

Published online by Cambridge University Press:  21 June 2016

N. Joel Ehrenkranz ,
Debra E. Nerenberg ,
James M. Shultz  and
Kenneth C. Slater
N. Joel Ehrenkranz*
Affiliation:
Florida Consortium for Infection Control, South Miami, Florida
Debra E. Nerenberg
Affiliation:
Florida Consortium for Infection Control, South Miami, Florida
James M. Shultz
Affiliation:
Florida Consortium for Infection Control, South Miami, Florida
Kenneth C. Slater
Affiliation:
Florida Consortium for Infection Control, South Miami, Florida
*
5901 S. W. 74th Street, Suite 300, South Miami, FL 33143
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Abstract

Objectives:

Current efforts to contain antimicrobial costs in hospitals are based on restricting drugs. We explored the effects of unsolicited case-specific recommendations to physicians to discontinue parenteral antimicrobial therapy in medically stable patients with pneumonia, in order to shorten hospital length of stay

Methods:

A nurse-interventionist, working as an emissary of an appropriate committee in 3 nonteaching community hospitals, presented randomly assigned physicians with nonconfrontational suggestions to substitute comparable oral antimicrobials for parenteral antimicrobials. Blinded observers evaluated in-hospital and 30-day postdischarge courses of patients of physicians who had been contacted by the nurse (cases) and those who had not (controls).

Results:

Eighty-two patient episodes (47 physicians) met study criteria. There were 53 cases and 29 controls. In 42 of 53 (79%) case episodes, physicians discontinued parenteral antimicrobials; patients' mean length of stay was 2.4 days less than for 29 control episodes (estimated cost savings was $884/patient). In 11 (21%) episodes, case physicians continued parenteral therapy; patients' mean length of stay was 1.9 days longer than for controls (estimated cost excess was $704/patient). Education, training and practice characteristics were comparable in physician groups. Severity of illness indicators and postdischarge outcomes were comparable in patient groups.

Conclusions:

The major cost-saving potential for shifting from par-enter-al to oral antimicrobial therapy is shortened length of stay. Timely information about alternative drug therapies, offered on a patient-specific basis, appears to modify the treating behavior of physicians. The program as currently conducted is cost-effective, with an estimated net savings of $50,000 per 100 interventions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 1 , January 1992 , pp. 21 - 32
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

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