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P9 ARE RESPIRATORY PHYSICIANS BETTER AT DISCHARGING PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA?
T Bewick, VJ Cooper, WS Lim. Nottingham City Hospital, Nottingham, UK
Introduction: We aimed 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 triage, acute medical patients who are not severely ill and therefore likely to have a short LOS 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 of “any respiratory tract infection” were examined. Patients who had CAP were grouped depending on whether they had seen a respiratory (group A) or non-respiratory (group B) consultant physician on the ESSU post-take ward round. Patients with empyema, post obstructive pneumonia due to lung cancer and immunosuppression due to haematological malignancy were excluded. Patients with a diagnosis of cellulitis over the same time period were used as controls.
Results: 1093 patients were admitted with respiratory tract infections and 1117 with cellulitis over the study period. CAP was diagnosed and treated in 499. 30 patients met the exclusion criteria and were omitted from further analysis. Patients discharged by the registrar before seeing a consultant (46 CAP, 173 cellulitis) and patients admitted over a weekend (128 CAP, 281 cellulitis) were also excluded. The LOS for patients with CAP in group A (n = 116, median 2.04 days; interquartile range (IQR) 0.98–4.62) was significantly shorter compared with patients in group B (n = 179, median 2.84 days; IQR 1.11–5.95; p<0.05). There was a trend towards a higher percentage of discharges on day one in group A (40.5% vs 36.8%, p = 0.53). There was no significant difference between the two groups with cellulitis in LOS (group A n = 231, median 2.86 days …