The clinical benefit of in-hospital observation in 'low-risk' pneumonia patients after conversion from parenteral to oral antimicrobial therapy.

OBJECTIVE

To assess the benefit of in-hospital observation in "low-risk" patients with community-acquired pneumonia.

DESIGN

Retrospective review of data from a prospective study.

SETTING

Teaching community hospital.

PATIENTS

We studied 717 consecutive, adult patients admitted to the hospital for pneumonia.

MEASUREMENTS AND RESULTS

One hundred forty-five patients were classified at low-risk for complications using previously studied criteria; 144 (99%) charts were available for review. Two patients had "obvious reasons for continued hospitalization" on the day of antibiotic conversion and were excluded. One hundred two patients were observed, and 40 were not observed in-hospital after switch to oral antibiotics. No patient from either group required medical intervention within 24 h after hospital discharge. Five "observed" patients (5%, 95% confidence interval [CI], 2 to 11%) returned to the emergency department, three (3%; 95% CI, 0 to 9%) with respiratory complaints. Two (2%; 95% CI, 0 to 7%) "observed" patients were admitted to the hospital with recurrent pneumonia. One (3%; 95% CI, 0 to 13%) "not observed" patient returned to the emergency department with a nonrespiratory complaint and was not admitted. No patient from either group died within 30-day clinical follow-up. The length of stay for the "observed" and "not observed" groups was 98+/-33 h and 83+/-49 h, respectively. The difference in length of stay was 15 h (95% CI, 3 to 27).

CONCLUSIONS

In-hospital observation for low-risk patients admitted with community-acquired pneumonia after switch from parenteral to oral antibiotics is of limited benefit, and elimination of this practice could potentially reduce length of stay by almost 1 day per patient. This could translate into a cost savings of $57,200 for the 22-month study period. These results require prospective validation in a larger study.