Document Detail

Implementation of community-acquired pneumonia guidelines at a public hospital in Brazil.
MedLine Citation:
PMID:  21537650     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To implement community-acquired pneumonia (CAP) guidelines at a public hospital in Brazil and to evaluate the impact of these guidelines on health care quality.
METHODS: A quasi-experimental study, with a before-and-after design, involving adult patients diagnosed with CAP and hospitalized between July of 2007 and October of 2008 in the general ward of the Marília School of Medicine Hospital das Clínicas, located in the city of Marília, Brazil.
RESULTS: During the study period, 68 patients were diagnosed with CAP: 48 before the implementation of the guidelines and 20 after their implementation. After the implementation of the guidelines, 85% of the cases were treated in accordance with the guidelines, and there was a significant increase in the use of antibiotic therapy for atypical bacteria in patients with severe CAP (6.3% vs. 75.0%; p < 0.001). Comparing the pre-implementation and post-implementation periods, we observed a trend toward a decrease in the mortality (35.4% vs. 15.0%; p = 0.09) and toward an increase in the recording of SpO₂ in the medical charts of the patients (18% vs. 30%; p = 0.42). During the study period, the degree of severity was not recorded on the medical charts of most patients. In addition, the initiation of antibiotic therapy followed a pre-established schedule, regardless of the severity of the infection.
CONCLUSIONS: This study showed that, although the development and implementation of CAP guidelines promoted the optimization of the treatment, there were no significant differences regarding the assessment of severity, SpO₂ recording, or the initiation of antibiotic therapy. Therefore, strategies that are more effective are needed in order to modify variables related to the work of physicians and nurses.
Lucieni Oliveira Conterno; Fábio Ynoe de Moraes; Carlos Rodrigues da Silva Filho
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Jornal brasileiro de pneumologia : publicaça̋o oficial da Sociedade Brasileira de Pneumologia e Tisilogia     Volume:  37     ISSN:  1806-3756     ISO Abbreviation:  J Bras Pneumol     Publication Date:    2011 Mar-Apr
Date Detail:
Created Date:  2011-05-03     Completed Date:  2011-12-29     Revised Date:  2013-09-26    
Medline Journal Info:
Nlm Unique ID:  101222274     Medline TA:  J Bras Pneumol     Country:  Brazil    
Other Details:
Languages:  eng; por     Pagination:  152-9     Citation Subset:  IM    
Marília School of Medicine, Marília, Brazil.
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MeSH Terms
Aged, 80 and over
Anti-Bacterial Agents / classification,  therapeutic use
Brazil / epidemiology
Community-Acquired Infections / drug therapy,  mortality
Hospitals, Public
Middle Aged
Oxygen Consumption / physiology
Pneumonia / drug therapy*,  mortality
Practice Guidelines as Topic*
Quality of Health Care / standards*
Time Factors
Young Adult
Reg. No./Substance:
0/Anti-Bacterial Agents
Comment In:
J Bras Pneumol. 2011 Mar-Apr;37(2):139-41   [PMID:  21537647 ]

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