Title Improved treatment of community-acquired pneumonia through tailored

interventions: Results from a controlled, multicenter quality improvement project

Author/s Seerup, R. Israelen, S. Ravn, P. et al.
Date Published 2020, June 11
Description Community-acquired pneumonia (CAP) is a common disease and causes significant
morbidity and mortality, particularly among the elderly and patients with comorbidity.
In Denmark, CAP accounts for approximately 45.000 hospitalizations annually, with
a 30-day mortality of 10–15%.
In recent decades, professional societies have developed evidence-based
guidelines to assist clinicians in treating patients with CAP. Adherence to these
guidelines can reduce antibiotic exposure, length of stay, mortality and health care
costs without negatively affecting patient outcomes.
Content: To improve the guideline-based treatment of patients with CAP admitted to hospital,
a quality improvement stud was designed. 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, multiple interventions was applied 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, in
continuity with a 4-month follow-up period to assess the sustainability of the
improvements.
Background Community-acquired pneumonia (CAP) is one of the leading causes of healthcare
utilization and death worldwide. Treatment according to evidence-based clinical
guidelines can reduce mortality, antibiotic exposure and length of hospital stay
related to CAP.
Results The care bundle utilization 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).
Conclusions The 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.
Summary What is already known about this topic?
Statement - Community-acquired pneumonia (CAP) is a common disease and causes
significant morbidity and mortality, particularly among the elderly and patients with
comorbidity. In Denmark, CAP accounts for approximately 45.000 hospitalizations
annually, with a 30-day mortality of 10–15%. Several studies indicate that physicians
show a low grade of guideline adherence when managing patients with CAP.

What does this paper add?

-Thematically analyzed data involving several steps with credibility, transferability,
conformability and dependability were emphasized during the data collection
process.

The implications of this paper

- At baseline, completion rates for all defined indicators varied, and the study sites
faced different challenges regarding the management of CAP patients. It aimed to
improve patient care by increasing adherence to CAP guidelines through the
implementation of tailored interventions.
Reference Seerup, R. Israelen, S. Ravn, P. et al. Improved treatment of community-acquired
pneumonia through tailored interventions: Results from a controlled, multicenter
quality improvement project.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232308