Assessment of empiric outpatient therapy and readmission rates from the emergency department for community acquired pneumonia

Abstract

Background: Community acquired pneumonia (CAP) is a common reason for emergency department visits and is associated with high mortality and readmission rates. The Center for Medicare and Medicaid Services (CMS) aims to decrease readmission rates for pneumonia through their Hospital Readmissions Reduction Program (HRRP) that was initiated in 2012. One study investigated avoidable causes of CAP readmission and discovered that the highest percentage of avoidable causes of readmission was related to discharging patients with either missing or incorrect diagnosis or therapy (31.7%). Emergency department (ED) physicians are in a unique position to impact these factors, as they are often responsible for initial diagnosis and empiric therapy initiation. The purpose of this study is to identify adherence to guideline-recommended empiric therapy and utilize the data to develop targeted interventions to refine our current practices.

Methods: This study was performed as a single-center, retrospective, observational chart review. The study period was July 1, 2021-June 30, 2022, and the study included ED patients with an ICD-10 diagnosis code for pneumonia. Patients were independently reviewed by two investigators, with a third available for final statistical decision if needed. Each patient was reviewed for inclusion and exclusion criteria, and appropriateness of empiric therapy was evaluated according to the 2019 CAP guidelines. Patients were also reviewed for readmission within 30 days.

Results: Data collection and analysis is still ongoing for this project. There were 169 total patients with a diagnosis code for CAP discharged from the emergency department during the pre-specified timeframe. For preliminary results 39 charts have been completed. 29 charts met inclusion criteria. Of these, only 2 had received appropriate empiric therapy. There were 10 total readmissions, with 3 of them being due to worsening pneumonia. None of the patients readmitted for worsening pneumonia had received appropriate empiric therapy. Extended duration and incomplete regimens for patients with comorbidities were the most common reasons for inappropriate therapy. Based on preliminary data, only 6% of patients received appropriate empiric therapy for CAP. Readmission rate overall was 35%, and rate of readmission for worsening pneumonia was 10%.

Conclusions: Based on preliminary data, overall prescribing habits from the emergency department are not adherent with the guidelines. There is insufficient data to draw conclusions about the effect of this on readmission. Targeted provider education will be developed based on the most common reasons for incorrect therapy, with the goal of improving guideline adherence.