Decision-support tool reduces deaths from pneumonia in emergency departments

12 September 2013

A trial of an electronic decision support tool that is linked to patients' electronic medical records showed it helped to reduce deaths from pneumonia in emergency departments by up to 25%.

The findings were presented at the European Respiratory Society (ERS) Annual Congress in Barcelona on 11 September 2013.

Researchers from Intermountain Healthcare and the University of Utah in the USA tested the effectiveness of the tool on pneumonia patients in seven emergency departments.

A group of 2,450 patients were assessed when using the electronic tool and compared to a group of 2,308 patients that were analysed before the electronic tool was used. 

In both groups the researchers looked at hospital admission rates, length of hospital stay, deaths, secondary hospitalisation rates and adherence to guidelines.

The results showed a significant reduction in death rates in the emergency departments where the tool was used. Crude inpatient mortality rate fell from 5.3% to 3.5% and, after adjusting for severity, the relative risk of death was reduced by 25%.

The researchers developed an electronic tool because it is often difficult to fully implement existing guidelines in an emergency setting. The tool is linked to a patient’s electronic medical record, so unlike a paper guideline, it automatically extracts data that predict the severity of pneumonia. The tool then provides recommendations regarding where the patient should be admitted to, which diagnostic tests are best to use and which antibiotics are most appropriate.

Dr Barbara Jones, leading author of the study, said: “We are encouraged by the impact that our tool has had on death rates, and feel that it is most likely due to more accurate severity assessment and antibiotic decisions being made in accordance with the guidelines. While we are encouraged by the results, we plan to collect more data to explore how the tool is making this impact.”

Dr Nathan Dean, senior author of the study, said: “Although doctors are free to choose at any time whether to follow the recommendations, we think that a tool that is individualised and integrated into the electronic health record is a much more efficient way of supporting decision-making and making treatment guidelines quickly accessible during an emergency situation.”