Pneumonia Guidelines in a Rural Health Care Setting
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Authors
Peterson, Shannon
Iverson, Lindsay
Issue Date
2014-06-03
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Abstract
Purpose: Quality indicators and mortality rates for acute myocardial infarction, congestive heart failure, and pneumonia have been reviewed in studies, with critical access hospitals (CAHs) consistently having worse outcomes compared to urban and non-CAH systems. Research regarding patient outcomes specific to rural health care is needed as it is not represented in current literature. The purpose of this quality improvement project was to evaluate pneumonia patient outcomes in a 25-bed CAH in the rural Midwest.
Methods: This study utilized a retrospective design of a convenience sample of all pneumonia patients admitted one year before (n=81) and one year after (n=70) the May 2012 care map implementation. Patient demographics, comorbidities, 30-day mortality, use of guidelines for initial antibiotic therapy (IAT), and length of stay (LOS) were analyzed using frequencies, Fisher’s exact test, and Wald’s Chi square as appropriate.
Findings: Antibiotic therapy concordant with community acquired pneumonia (CAP) was provided for 105 of the 150 patients, regardless of health care-associated pneumonia (HCAP) or CAP categorization. In hospital mortality, rate of guideline IAT and time to clinical stability outcomes did not have a significant difference. Significant improvement was achieved in 30-day mortality (P=.0208), CDSS use (P=.0128), and LOS (P=.0150) after implementation of an evidence-based practice pneumonia care map
Conclusion: CAH systems provide essential, caring, and quality service. Implementation of a pneumonia care map significantly improved patient outcomes.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University
Please contact Shannon Peterson, RN, BSN for permission.
Please contact Shannon Peterson, RN, BSN for permission.