Audit of Physicians’ Adherence to a Preprinted Order Set for Community-Acquired Pneumonia
Bibliographic record
Abstract
Background: Community-acquired pneumonia is the seventh leading cause of death in Canada. Previous studies have shown reductions in both mortality rate and length of hospital stay with the use of guidelineconcordant empiric therapy and standardized preprinted orders.Objectives: The primary objective was to determine adherence to the preprinted order for community-acquired pneumonia at the University Hospital of Northern British Columbia (UHNBC). The study also had the following secondary objectives: to assess the appropriateness of prescribing of levofloxacin in relation to institutional recommendations; to determine adherence with recent guidelines from the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) for the treatment of community-acquired pneumonia; and to determine allcause mortality, duration of IV antibiotic therapy, and length of stay for the various regimens reviewed.Methods: A retrospective observational chart review was conducted of patients with community-acquired pneumonia who were admitted between November 2007 and February 2008. Exclusion criteria were designed to eliminate patients who did not have this condition. Descriptive statistics were used to assess adherence with the preprinted order. Secondary outcomes were analyzed with the Pearson χ2 test, t tests, and analysis of variance.Results: In total, the charts for 113 patients were reviewed, and 58 patients were included in the study. The preprinted order for communityacquired pneumonia was used for 25 (43%) of the 58 patients; however, for only 4 (7%) of these admissions were all sections of the preprinted order used correctly. No statistically significant differences in length of stay were found for any of the antibiotic combinations assessed. However, the proportion of patients treated according to the IDSA-ATS guidelines was significantly greater when the preprinted order was used (p = 0.012). In addition, use of the preprinted order encouraged assessment of the patient's pneumococcal vaccination status (9 [25%] of 25 patients versus 3 [9%] of 33 patients) and utilization of the pneumonia severity index (13 [52%] of 25 patients versus 0 [0%] of 33 patients).Conclusion: The preprinted order for community-acquired pneumonia at UHNBC was not being utilized to its fullest. However, when it was used, it increased guideline-concordant empiric therapy and encouraged assessment of patients' pneumococcal vaccination status and pneumonia severity index.RÉSUMÉContexte : La pneumonie extra-hospitalière est la septième principale cause de mortalité au Canada. Des études ont montré que le taux de mortalité et la durée de l'hospitalisation diminuaient avec l'emploi d'un traitement empirique conforme aux lignes directrices et l'utilisation d'ordonnances préimprimées standardisées.Objectifs : Le principal objectif était de déterminer le taux d'observance à une ordonnance préimprimée actuellement utilisée au University Hospital of Northern British Columbia pour la prise en charge de la pneumonie extra-hospitalière. L'étude comportait aussi les objectifs secondaires suivants : évaluer la pertinence de la prescription de la lévofloxacine relativement aux recommandations de l'établissement; déterminer l'observance des récentes lignes directrices de l'Infectious Diseases Society of America (IDSA) et de l'American Thoracic Society (ATS) dans la prise en charge de la pneumonie extra-hospitalière; et rendre compte des décès toutes causes confondues, de la durée de l'antibiothérapie intraveineuse et de la durée de l'hospitalisation pour les divers schémas examinés.Méthodes : On a effectué une analyse d'observation rétrospective des dossiers médicaux des patients atteints de pneumonie extra-hospitalière qui ont été hospitalisés entre novembre 2007 et février 2008. Les critères d'exclusion ont été conçus pour éliminer les cas non atteints de cette maladie. Des statistiques descriptives ont été calculées pour évaluer l'observance de l'ordonnance préimprimée. Les paramètres d'évaluation secondaires ont été analysés à l'aide du test du chi carré de Pearson, des tests de t et de l'analyse de variance.Résultats : Au total, les dossiers médicaux de 113 patients ont été analysés et 58 inclus dans l'étude. L'ordonnance préimprimée pour la prise en charge de la pneumonie extra-hospitalière a été utilisée chez 25 (43 %) des 58 patients; cependant, toutes les sections de l'ordonnance préimprimée n'ont été remplies correctement que pour seulement 4 (7 %) de ces patients hospitalisés. Aucune différence statistiquement significative n'a été observée dans la durée de l'hospitalisation pour toutes les combinaisons d'antibiotiques analysées. En revanche, la proportion de patients traités conformément aux lignes directrices de l'IDSA-ATS était considérablement plus élevée lorsque l'ordonnance préimprimée était utilisée (p = 0,012). De plus, le recours à celle-ci a favorisé l'évaluation de l'état vaccinal antipneumococcique des patients (9 [25 %] des 25 patients contre 3 [9 %] des 33 patients) et l'utilisation de l'indice de gravité de la pneumonie (13 [52 %] des 25 patients contre 0 [0%] des 33 patients).Conclusion : L'ordonnance préimprimée pour la prise en charge de la pneumonie extra-hospitalière n'était pas utilisée à son plein potentiel au University Hospital of Northern British Columbia. Cependant, lorsqu'elle était utilisée, elle a accru l'observance du traitement empirique aux lignes directrices et favorisé l'évaluation de l'état vaccinal antipneumococcique des patients et l'utilisation de l'indice de gravité de la pneumonie.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.027 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".