A Multidisciplinary Pathway for Community-Acquired Pneumonia with Rapid Conversion to Oral Therapy Improves Healthcare Value

A multidisciplinary team with a goal to improve treatment for hospitalized patients with CAP was assembled that included physicians (emergency medicine, medical intensive care unit, infectious disease/antimicrobial stewardship, hospitalists), pharmacy, value engineering, information technology and the quality department. A standardized CAP orderset for patients presenting to the ED was developed. When an ED patient receives a chest radiograph and an antibiotic order, a best practice alert (BPA) is triggered stating, "If this antibiotic is for pneumonia, click ‘Open orderset'." If selected, this orderset provides guidance to providers to appropriately triage patients (ICU admission, Floor admission or Home Discharge), assess the risk for drug resistance, order appropriate diagnostic testing, and select ‘best practice' antibiotics. Patients admitted to the hospital floor are given a single intravenous (IV) antibiotic dose, then are switched to oral antibiotics after 24 hours for a total duration of 5 days. Atypical coverage with azithromycin is discontinued after 24 hours unless Legionella urine antigen returns positive. Pre-implementation training was provided to providers, nurses, respiratory therapists and pharmacists involved in patient care. A stewardship team including an infectious disease physician and pharmacist would review charts of patients on hospitalists teams and provide feedback for consistent antibiotic administration.