SESSION TITLE: Improving Quality and Reducing Cost
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 29, 2013 at 02:45 PM - 04:15 PM
PURPOSE: With healthcare expenditures in the United States rising, focus has shifted towards eliminating unnecessary costs. Admission of patients that could be treated in an outpatient setting misuses hospital resources and places patients at risk for complications such as nosocomial infections. We hypothesized that persons evaluated for pneumonia in the ER were not being triaged appropriately, which may account for excess healthcare expenses.
METHODS: We reviewed the medical records of patients given an ICD-9 diagnosis of “pneumonia” in the ER during 2011-2012. Appropriate triage for pneumonia was based on the validated CURB-65 pneumonia severity score. A score >3 points is considered “high severity” with hospitalization recommended; a score of 2 points is “moderate severity” and hospitalization should be considered. Patients with a score <2 points are considered “low severity” and outpatient therapy is appropriate. Patients were excluded from this study if they had factors for admission independent of pneumonia: a concomitant new diagnosis, immunocompromised state, recent failure of outpatient antibiotic therapy, criteria met for healthcare-associated pneumonia, or incorrect ICD-9 diagnosis coded on admission.
RESULTS: 328 randomized patient charts were reviewed, and 174 patients met inclusion criteria. 72% of patients (n=125) had a CURB-65 score <2 and 22% of these patients (n=27) were admitted. 13% of patients (n=22) were admitted with a score of 2. The average length of stay for patients with a score <2 was 1.6 days, with a calculated average cost of approximately $4,040 per patient admission.
CONCLUSIONS: Patients are being hospitalized for pneumonia despite low CURB-65 scores in the absence of other clinically justifiable reasons. This has led to excess hospital expenditures and inherent health hazards associated with admissions. The burden of healthcare costs can be mitigated by proper identification of patients eligible for admission according to guidelines. Such goals can be achieved with the implementation of protocols in the ER and the presence of a case manager to review potential admissions.
CLINICAL IMPLICATIONS: Inappropriate admission for pneumonia can be costly for the patient’s health and for the hospital.
DISCLOSURE: The following authors have nothing to disclose: Miranda Tan, Birju Bhatt, Tariq Niazi, Neil Kothari
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