A Multidisciplinary Approach to Streamline Care for Community-Acquired Pneumonia (CAP)
Faculty members from the Division of Infectious Diseases (Dr. Emily Spivak), General Internal Medicine (Dr. Claire Ciarkowski) and the Division of Pulmonary and Critical Care (Dr. Nate Hatton), in collaboration with colleagues from the Department of Emergency Medicine, Pharmacy, Antimicrobial Stewardship and Value Engineering designed and implemented a Best Practice Care Pathway for community-acquired pneumonia (CAP) in the fall of 2017. This physician-led pathway for one of the most common inpatient infectious diagnoses, is one of the first at the University of Utah to involve not only multiple clinical groups, but also span the entire patient encounter from the Emergency Department to the MICU and/or the floor.
Providers in the ED ordering a chest x-ray and antibiotics are alerted to potential patients eligible for the CAP Care Pathway or it can be accessed through the admission order set. The pathway focuses on guideline recommendations and best practices for CAP diagnosis, guideline-recommended and local microbiology supported empiric antibiotic therapy, de-escalation and prompt conversion to oral antibiotic therapy for patients on the medical floors, and evidence-based shortest effective duration of therapy. In addition to the orderset, CAP patients are reviewed daily by the Antimicrobial Stewardship team with feedback given to providers who stray from the pathway.
The CAP Care Pathway showed significant quality and financial impacts based on analysis of patients a year before and after implementation. Adherence with recommended diagnostic tests improved while duration of intravenous antibiotic therapy shortened. Length of stay was reduced by almost 2/3 of a day. This streamlined care was associated with no change in in-patient mortality or 30-day readmissions. The CAP Care Pathway combined with Antimicrobial Stewardship review saved an estimated $800,000 in the year after implementation.
Resource investment, multidisciplinary leadership and clinical buy-in was key to the success of this initiative.
To access the CAP Care Pathway type “CAP” into the orderset tab. Email Dr. Emily Spivak (emily.spivak@hsc.utah.edu), Dr. Claire Ciarkowski (claire.ciarkowski@hsc.utah.edu) or Dr. Nate Hatton (nathan.hatton@hsc.utah.edu) with questions.