Electronic Pneumonia Support Tool Might Reduce Mortality in ED Patients

The electronic pneumonia clinical decision support tool (ePNa) has a knowledge base formed by the scientific guidelines used to help clinicians diagnose and treat pneumonia. ePNa extracts real-time and historical data from the electronic health record (EHR) to guide diagnosis, risk stratification, ordering of microbiology studies, site of care decisions, and treatment. Clinical decision support may decrease unnecessary variation and improve care. To further explore its use pneumonia, Dr Nathan C Dean and his team conducted a study to examine patient outcomes and processes of care following the deployment of ePNa: comprehensive, open loop, real-time clinical decision support embedded within the electronic health record.

In a pragmatic, stepped-wedge, cluster-controlled trial, the researchers included all adult emergency department patients with pneumonia over three years identified by ICD-10 discharge coding confirmed by chest imaging. They included a total of 6848 patients for this study: 4536 from before ePNa deployment and 2312 from after deployment. They deployed ePNa into 6 geographic clusters of 16 Intermountain Healthcare hospital EDs at 2-month intervals between December 2017 and November 2018. They further conducted several post hoc sensitivity analyses.

Key findings of the study:

• Upon analysis, the researchers observed 30-day all-cause mortality, including both outpatients and inpatients, was 8.6% before deployment and 4.8% after deployment of ePNa.
• Upon mixed-effects regression model, they found an odds ratio (OR) of 0.62 for mortality after deployment.
• In the mixed-effects sensitivity model, they found that the mortality decreased by 3.8% after ePNa deployment (8.6% predeployment vs 4.8% post).
• They noted that the meantime from emergency department admission to the first antibiotic was around 160 minutes at baseline and 151 after deployment.
• They also noted that ePNa concordant antibiotic prescribing increased from 83.5 to 90.2%.
• They observed that outpatient disposition from the emergency department increased from 29.2% to 46.9% while 7-day secondary hospital admission was unchanged, 5.2% versus 6.1%.

The authors concluded, "ePNa deployment was associated with improved processes of care and lower mortality."

They further plan to develop an interoperable version of the tool for use across different EHRs at health systems other than Intermountain.

For further information:

DOI: https://doi.org/10.1164/rccm.202109-2092OC

Keywords: electronic pneumonia clinical decision support tool, ePNa, pneumonia, Intermountain decision support tool, mortality, antibiotic use, emergency department, Vitals, real-time monitoring, American Journal of Respiratory and Critical Care Medicine.