Standardized Emergency Care for Community Acquired Pneumonia (CAP)

Study Overview
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Brief Summary
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Community acquired pneumonia (CAP) is associated with a high in-hospital mortality. Standardization of diagnostics and adherence to sepsis bundles in the emergency department (ED) are associated with reduced mortality in patients with sepsis. Investigators examined whether the introduction of standardized care bundles and check lists in the ED are associated with a reduced mortality rate in patients hospitalized for CAP. This is an observational trial. The investigators retrospectively analyzed performance indicators of 2819 consecutive patients with CAP admitted to the Nuremberg Hospital, Germany, from 2008 to 2009. At the turn of the year, implementation of CAP care bundles took place including interprofessional education, checklists and institutionalized feedback. Primary endpoint was in-hospital mortality of CAP patients. After the implementation of CAP care bundles in the ED, mortality of affected patients was significantly lower in 2009 compared to 2008. This study should demonstrate that the implementation of a standardized CAP care bundle in the ED is associated with a risk reduction in affected patients. Standardization of diagnostic and therapeutic processes in the ED therefore improves the outcome of patients hospitalized for CAP.

Official Title
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Reduction of Mortality in Community-Acquired Pneumonia After Implementing Standardized Care Bundles in the Emergency Department

Conditions
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Community Acquired Pneumonia, Pneumonia, Infection

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: all patients with community acquired pneumonia Exclusion Criteria: exacerbation of chronic obstructive pulmonary disease malignancy immunosuppression neutropenia

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| CAP<br>A patient with CAP was identified by encoding pneumonia without severe immunosuppression (HIV infection, solid organ or bone marrow/stem cell transplants, severe neutropenia) as the main diagnosis (ICD 10 GM) of hospital admission. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mortality of CAP patients |  | up to 14days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mortality up to 14days in subgroups | Mortality of patients upt to 14day is determined in subgroups (different age groups, sub-groups of CRB-risk classes) CRB-65: C mental confusion; R respiratory rate ≥30/min; B systolic blood pressure <90 mm Hg; 65, age ≥65 years | up to 14 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Community Acquired Pneumonia, Emergency Department, Standardized Care, Reduced Mortality, CRB-65 Risk Classes, Antibiotic Therapy