Standardized Emergency Care for Community Acquired Pneumonia (CAP)

Reduction of Mortality in Community-Acquired Pneumonia After Implementing Standardized Care Bundles in the Emergency Department

Community acquired pneumonia (CAP) is associated with a high in-hospital mortality. Standardization of diagnostics and adherence to sepsis bundles in the emergency department (ED) are associated with reduced mortality in patients with sepsis. Investigators examined whether the introduction of standardized care bundles and check lists in the ED are associated with a reduced mortality rate in patients hospitalized for CAP.

This is an observational trial. The investigators retrospectively analyzed performance indicators of 2819 consecutive patients with CAP admitted to the Nuremberg Hospital, Germany, from 2008 to 2009. At the turn of the year, implementation of CAP care bundles took place including interprofessional education, checklists and institutionalized feedback. Primary endpoint was in-hospital mortality of CAP patients. After the implementation of CAP care bundles in the ED, mortality of affected patients was significantly lower in 2009 compared to 2008. This study should demonstrate that the implementation of a standardized CAP care bundle in the ED is associated with a risk reduction in affected patients. Standardization of diagnostic and therapeutic processes in the ED therefore improves the outcome of patients hospitalized for CAP.

Study Overview

• Status: Completed
• Conditions: Pneumonia; Infection; Community Acquired Pneumonia

• Study Type: Observational
• Enrollment (Actual): 2819

Contacts and Locations

Study Locations

• Germany
  • Bavaria
    • Nuremberg, Bavaria, Germany, 90419
      • City Hospital Nuremberg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Emergency department patients

Description

Inclusion Criteria:

• all patients with community acquired pneumonia

Exclusion Criteria:

• exacerbation of chronic obstructive pulmonary disease
• malignancy
• immunosuppression
• neutropenia

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
CAP; A patient with CAP was identified by encoding pneumonia without severe immunosuppression (HIV infection, solid organ or bone marrow/stem cell transplants, severe neutropenia) as the main diagnosis (ICD 10 GM) of hospital admission.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
mortality of CAP patients	up to 14days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
mortality up to 14days in subgroups	Mortality of patients upt to 14day is determined in subgroups (different age groups, sub-groups of CRB-risk classes) CRB-65: C mental confusion; R respiratory rate ≥30/min; B systolic blood pressure <90 mm Hg; 65, age ≥65 years	up to 14 days

Collaborators and Investigators

• Sponsor: Klinikum Nürnberg

Study record dates

Study Major Dates

• Study Start: January 1, 2007
• Primary Completion (Actual): December 1, 2012
• Study Completion (Actual): December 1, 2012

Study Registration Dates

• First Submitted: October 10, 2013
• First Submitted That Met QC Criteria: October 15, 2013
• First Posted (Estimate): October 16, 2013

Study Record Updates

• Last Update Posted (Estimate): October 16, 2013
• Last Update Submitted That Met QC Criteria: October 15, 2013
• Last Verified: October 1, 2013

More Information

Terms related to this study

• Keywords: Emergency Department; Antibiotic Therapy; Community Acquired Pneumonia; Standardized Care; Reduced Mortality; CRB-65 Risk Classes
• Additional Relevant MeSH Terms: Pathologic Processes; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Lung Diseases; Disease Attributes; Emergencies; Pneumonia
• Other Study ID Numbers: CAP01ED