Impact of a Clinical Pathway for Hospital Management of Community-Acquired Pneumonia: A Retrospective Cohort Study

Abstract

Introduction: Community-acquired pneumonia is a prevalent disease that is managed in heterogeneous ways. Clinical pathways have been proposed as one way to mitigate this variability, but few implementation experiences have been published. The primary objective of this study is to analyse the effects of implementing a standardised clinical pathway for community-acquired pneumonia on length of hospital stay. Methods: Retrospective cohort study comparing two equivalent time periods with and without a clinical pathway. We described patient characteristics in both periods and compared mean length of hospital stay, mortality, rate of complications, and readmissions within 30 days. Results: A total of 170 patients were included across both periods. Mean length of hospital stay in patients treated before implementation of the clinical pathway was 6.05 days versus 5.43 days afterward (p = 0.28). The segmented regression analysis showed a change in slope for the length of hospital stay (0.04) following implementation of the clinical pathway. The proportion of patients hospitalised for more than 6 days was 37.5% in the first period, compared to 29.6% in the second (p = 0.088). Multivariable analysis showed that nonadherence to the clinical pathway was associated with a hospital stay of longer than 6 days (p = 0.048). Mortality dropped from 10.5% to 4.7% after the clinical pathway was established (p = 0.12). The proportion of patients readmitted within 30 days due to CAP was 8.8% before the establishment of the clinical pathway and 0% afterwards (p = 0.006). Conclusion: A clinical pathway for managing community-acquired pneumonia was associated with a reduction in length of hospital stay and readmittance. There was a trend towards mortality reduction.