Steps to Take to Reduce Length of Hospital Stay in Patients With Lower Respiratory Tract Infections

Background: Identification of medical and nonmedical requirements for outpatient treatment and/or early hospital discharge have potential to decrease health care costs. Method: On admission and before discharge, physicians and nurses, patients, and their relatives were interviewed about requirements over five domains (medical, nursing, organizational, and patients’ and their relatives’ preferences) for outpatient management and/or early discharge. Results: From a total of 550 included patients, 136 (24.7%) potential outpatients and 265 (48.2%) potential patients for early discharge were identified. Specific medical and nursing factors and factors related to patients and relatives were identified as being important for initial outpatient treatment and/or early discharge. Conclusion: This survey shows important requirements from the perspective of different heath care workers, patients, and relatives, which could allow initial outpatient treatment and/or early discharge of a large proportion of lower respiratory tract infection (LRTI) patients.

Which patients with lower respiratory tract infections need inpatient treatment? Perceptions of physicians, nurses, patients and relatives

BACKGROUND

Despite recommendations for outpatient management, low risk patients with lower respiratory tract infections (LRTIs) are often hospitalized. This survey analyzed perceptions of physicians, nurses, patients and relatives about feasibility of outpatient management and required duration of hospital stay.

METHODS

We performed a prospective, observational questionnaire survey in hospitalized patients with LRTI as part of a multicenter trial. Treating physicians and nurses, patients and their relatives were asked on admission and before discharge about feasibility of outpatient treatment over 5 dimensions (medical, nursing, organizational factors, and patients' and relatives' preferences) using continuous scales.

RESULTS

On admission, 12.6% of physicians, 15.1% of nurses, 18.0% of patients and 5.2% of relatives believed that outpatient treatment would be possible. Before hospital discharge, 31.1% of physicians, 32.2% of nurses, 11.6% of patients and 4.1% of relatives thought that earlier discharge would have been feasible. Medical factors were the most frequently perceived motives for inpatient management. These perceptions were similar in all LRTI subgroups and independent of disease severity and associated expected mortality risks as assessed by the Pneumonia Severity Index (PSI).

CONCLUSION

Independent of type and severity of respiratory tract infection, the misperceived high severity and expected mortality and morbidity were the predominant reasons why treating physicians, nurses, patients and their relatives unanimously believed that inpatient management was necessary. Better assessment and communication about true expected medical risks might contribute to a pathway to shorten in-hospital days and to introduce a more risk-targeted and individually tailored allocation of health-care resources.

TRIAL REGISTRATION

NCT00350987.