Thorax. Published Online First: 21 April 2009. doi:10.1136/thx.2008.109983
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Does early review by a respiratory physician lead to a shorter length of stay for patients with non-severe community-acquired pneumonia?
1 Nottingham City Hospital, Nottingham, United Kingdom
2 Queen's Medical Centre, Nottingham, United Kingdom
* To whom correspondence should be addressed. E-mail: thomasbewick{at}doctors.org.uk.
Accepted 27 March 2009
Abstract
Background: The aim of this study was to evaluate whether patients with non-severe community-acquired pneumonia (CAP) have a shorter length of stay (LOS) when initially seen by a respiratory physician compared with a non-respiratory physician.
Methods: At Nottingham City Hospital, following nurse triage, acute medical patients who are not severely ill are admitted to the consultant-led emergency short stay unit (ESSU). Records of patients seen on ESSU between January 2004 and December 2007 with a clinical discharge code relating to CAP were retrospectively examined. Patients with a diagnosis of cellulitis over the same time period were used as controls. Patients were grouped depending on whether they were seen on their first post-take ward round by a respiratory consultant physician (Group A), non-respiratory consultant physician (Group B), or were admitted at the weekend (group C).
Results: Following exclusions, 426 patients with CAP and 935 patients with cellulitis were analysed. The median LOS for patients with CAP in Group A was 1.97 days (n=118, interquartile range 0.97-4.47) compared with 2.85 days for patients in group B (n=179, interquartile range 1.11-5.95; p<0.05). There was a trend towards a higher percentage of discharges within 24 hours of consultant review in group A compared with group B (40.7% versus 36.9%, p=0.53). There was no significant difference between groups A and B with cellulitis in LOS or percentage discharged within 24 hours of first consultant review.
Conclusion: Patients with non-severe CAP have a shorter hospital LOS when initially seen by a respiratory compared to non-respiratory physician.
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