Non-ventilator hospital-acquired pneumonia versus …...Prevention of hospital-associated pneumonia...
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Non-ventilator hospital-acquired pneumonia versus pneumonia as an admission diagnosis in patients who develop sepsis: Incidence and Cost Karen K. Giuliano, PhD, RN, FAAN, Hallmark Health System and Sage Products, LLC-Now Part of Stryker Barbara Quinn, MSN, RN, ACNS-BC, Sutter Health • Dian Baker, PhD, APRN, Professor of Nursing, California State University Sacramento BACKGROUND RESULTS CONCLUSIONS Evidence supports that non-ventilator hospital-acquired pneumonia (NV-HAP) contributes to prolonged hospital stays, is associated with significant patient morbidity/mortality, and occurs in approximately 0.5-1.8% of all hospital admissions. Pneumonia is a known risk factor for sepsis, and the Agency for Healthcare Research and Quality estimates the cost of sepsis at $20 billion (2011), with incidence increasing annually by 11.9%. Our objective was to compare incidence and cost in 2 groups of pneumonia patients with sepsis as a secondary diagnosis: patients with NV-HAP and patients admitted with pneumonia (AP). The incidence of sepsis was 36.3% (N=43,252) in the NV-HAP group, as compared to 1.9% (N=2,332) in the AP group. Additional comparisons are highlighted on Table 1. These findings add to the emerging body of knowledge on NV-HAP as a significant healthcare issue. The combination of NV-HAP and sepsis was associated with higher costs and LOS as compared to AP patients. While there were no differences in sepsis mortality, the higher incidence of sepsis with NV-HAP contributed to many more patient deaths as compared to patients admitted with pneumonia. We used the 2012 Healthcare Utilization Project (HCUP) National Inpatient Sample (NIS). The HCUP NIS is a sampling of inpatient records for a given year which includes diagnosis codes, billing information, and basic patient demographics. We identified: patients with NV-HAP (N=119,075)); and AP, randomly selected to match the NV-HAP group size. Within each group we reviewed sepsis as an associated secondary diagnosis. METHODS Table 1. Group Comparisons using Descriptive Statistics GROUP 1 Patients with NVHAP GROUP 2 Admitted with Pneumonia μ n % μ n % Clinical outcome variables Total charges Length of stay (days) Patient mortality Demographic variables Age (years) Female Male Number of chronic conditions $168,383 $113,209 8,847 626 20.5% 26.8% 66.4 68.4 7.4 6.8 15.2 12.4 20,376 1,144 22,874 1,188 47.1% 49.1% 52.9% 50.9% Giuliano K, Quinn B, & Baker (2017, in review). Non-ventilator Hospital Acquired Pneumonia: Incidence and Cost. Kollef, M. H. (2004). Prevention of hospital-associated pneumonia and ventilator-associated pneumonia. Critical care medicine, 32(6), 1396-1405. Quinn B, Baker DL, Cohen S, Stewart JL, Lima CA, Parise C. Basic nursing care to prevent nonventilator hospital-acquired pneumonia. Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau. 2014;46(1):11-19. 24960
Transcript of Non-ventilator hospital-acquired pneumonia versus …...Prevention of hospital-associated pneumonia...
Non-ventilator hospital-acquired pneumonia versus pneumonia as an admission diagnosis in patients who develop sepsis:
Incidence and CostKaren K. Giuliano, PhD, RN, FAAN, Hallmark Health System and Sage Products, LLC-Now Part of Stryker
Barbara Quinn, MSN, RN, ACNS-BC, Sutter Health • Dian Baker, PhD, APRN, Professor of Nursing, California State University Sacramento
BACKGROUND
RESULTS CONCLUSIONS
Evidence supports that non-ventilator hospital-acquired pneumonia (NV-HAP) contributes to prolonged hospital stays, is associated with significant patient morbidity/mortality, and occurs in approximately 0.5-1.8% of all hospital admissions.
Pneumonia is a known risk factor for sepsis, and the Agency for Healthcare Research and Quality estimates the cost of sepsis at $20 billion (2011), with incidence increasing annually by 11.9%.
Our objective was to compare incidence and cost in 2 groups of pneumonia patients with sepsis as a secondary diagnosis: patients with NV-HAP and patients admitted with pneumonia (AP).
The incidence of sepsis was 36.3% (N=43,252) in the NV-HAP group, as compared to 1.9% (N=2,332) in the AP group.
Additional comparisons are highlighted on Table 1.
These findings add to the emerging body of knowledge on NV-HAP as a significant healthcare issue. The combination of NV-HAP and sepsis was associated with higher costs and LOS as compared to AP patients.
While there were no differences in sepsis mortality, the higher incidence of sepsis with NV-HAP contributed to many more patient deaths as compared to patients admitted with pneumonia.
We used the 2012 Healthcare Utilization Project (HCUP) National Inpatient Sample (NIS).
The HCUP NIS is a sampling of inpatient records for a given year which includes diagnosis codes, billing information, and basic patient demographics.
We identified: patients with NV-HAP (N=119,075)); and AP, randomly selected to match the NV-HAP group size.
Within each group we reviewed sepsis as an associated secondary diagnosis.
METHODS
Table 1. Group Comparisons using Descriptive StatisticsGROUP 1
Patients with NVHAPGROUP 2
Admitted with Pneumoniaμ n % μ n %
Clinical outcome variables Total charges Length of stay (days) Patient mortality Demographic variables Age (years) Female Male Number of chronic conditions
$168,383 $113,209
8,847 62620.5% 26.8%
66.4 68.4
7.4 6.8
15.2 12.4
20,376 1,14422,874 1,188
47.1% 49.1%52.9% 50.9%
Giuliano K, Quinn B, & Baker (2017, in review). Non-ventilator Hospital Acquired Pneumonia: Incidence and Cost. Kollef, M. H. (2004). Prevention of hospital-associated pneumonia and ventilator-associated pneumonia. Critical care medicine, 32(6), 1396-1405. Quinn B, Baker DL, Cohen S, Stewart JL, Lima CA, Parise C. Basic nursing care to prevent nonventilator hospital-acquired pneumonia. Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau. 2014;46(1):11-19.
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