Critical pathway and variance analysis based on guidelines for community-acquired pneumonia in adults

Abstract

At the Okayama Medical Center a so-called variance analysis was carried out in order to determine the optimal length of hospital stay using a newly prepared critical pathway based on the Infectious Diseases Society of America (IDSA) / American Thoracic Society (ATS) guideline and the Japanese Respiratory Society (JRS) guideline for community-acquired pneumonia in adults. The treatment schedule of this critical pathway is as follows：administer intravenous β-lactum with oral macrolide as initial treatment for three days, if effective, the treatment is sustained up to the 7th hospital day, otherwise change β-lactum to intravenous quinolone, and the treatment is sustained up to the 10th hospital day.

Over the period from December 2006 to April 2008 eighteen patients were treated using this critical pathway. To simplify the variance, the length of hospital stay beyond 10 days was assumed as negative variance. WBC count and CRP on admission and their decrease rate on the 3rd hospital day were analyzed.

In conclusion, a low decrease rate of WBC count on the 3rd hospital day seemed to be an important factor for a prolonged hospitalization.