Fine M J, Medsger A R, Stone R A, Marrie T J, Coley C M, Singer D E, Akkad H, Hough L J, Lang W, Ricci E M, Polenik D M, Kapoor W N
Arch Intern Med. 1997 Jan 13;157(1):47-56.
The hospital discharge decision directly influences the length of stay in patients with community-acquired pneumonia, yet no information exists on how physicians make this decision.
To identify the factors physicians considered the factors responsible for extending length of hospital stay in clinically stable patients, and the outpatient medical services that would allow earlier hospital discharge for patients with community-acquired pneumonia.
Physicians responsible for the hospital discharge decision of patients with community-acquired pneumonia were asked to identify the factors responsible for extending stay in patients hospitalized beyond stability, and the medical services that could have allowed earlier hospital discharge to occur.
For the 418 eligible patients with community-acquired pneumonia identified during the study, 332 questionnaires (79%) were completed by 168 physicians. Physicians believed 71 patients (22%) were discharged from the hospital 1 day or more (median, 2.5 days) after reaching clinical stability. The most common factors rated as being "very important" in delaying discharge were diagnostic evaluation or treatment of comorbid illness (56%), completion of a "standard course" of antimicrobials (15%), and delays with arrangements for long-term care (14%). Among the 302 patients with available information on both length of hospital stay and stability at discharge, median length of stay was 7.0 days for the 29 low-risk patients hospitalized beyond reaching clinical stability and 5.0 days for the remaining 128 low-risk patients (P < .005); median length of stay was 12.5 days for the 42 medium- and high-risk patients hospitalized beyond reaching clinical stability and 8.0 days in the remaining 113 medium- and high-risk patients (P < .001). Frequently cited medical services that "probably" or "definitely" would have allowed earlier discharge to occur included availability of home intravenous antimicrobial infusion (26%) and home visits by nurses (20%).
Physicians believed that diagnostic evaluation or treatment of comorbid illness, completion of a standard course of antimicrobial therapy, and delays with arrangements for long-term care delayed hospital discharge in clinically stable patients. Addressing the efficiency of these aspects of inpatient medical care, as well as providing home treatment programs, could decrease the length of hospital stay in patients with community-acquired pneumonia.
医院出院决策直接影响社区获得性肺炎患者的住院时间，但目前尚无关于医生如何做出该决策的信息。
确定医生认为导致临床稳定患者住院时间延长的因素，以及可使社区获得性肺炎患者更早出院的门诊医疗服务。
负责社区获得性肺炎患者出院决策的医生被要求确定导致病情稳定后仍住院的患者住院时间延长的因素，以及本可使患者更早出院的医疗服务。
在研究期间确定的418例符合条件的社区获得性肺炎患者中，168名医生完成了332份问卷（79%）。医生认为71例患者（22%）在达到临床稳定后1天或更长时间（中位数为2.5天）出院。在延迟出院方面被评为“非常重要”的最常见因素是合并症的诊断评估或治疗（56%）、完成抗菌药物的“标准疗程”（15%）以及长期护理安排的延迟（14%）。在302例有住院时间和出院时稳定性信息的患者中，29例病情稳定后仍住院的低风险患者的中位住院时间为7.0天，其余128例低风险患者为5.0天（P<0.005）；42例病情稳定后仍住院的中高风险患者的中位住院时间为12.5天，其余113例中高风险患者为8.0天（P<0.001）。经常被提及的“可能”或“肯定”能使患者更早出院的医疗服务包括家庭静脉输注抗菌药物（26%）和护士家访（20%）。
医生认为合并症的诊断评估或治疗、抗菌药物标准疗程的完成以及长期护理安排的延迟会使临床稳定患者延迟出院。提高住院医疗护理这些方面的效率，并提供家庭治疗方案，可缩短社区获得性肺炎患者的住院时间。
