Hospital avoidable for some elderly with pneumonia

NEW YORK, June 11 (Reuters) Researchers in Canada have developed guidelines that help keep nursing home residents in the home and out of the hospital when they develop pneumonia, so long as their condition remains relatively stable.

To test the safety and feasibility of this approach, Dr Mark Loeb, from McMaster University in Hamilton, Ontario, and his associates randomly assigned ten nursing homes to use the guidelines -- a kind of decision tree, or ''clinical pathway'' -- while ten other homes followed their usual care practices.

In either case, when a patient showed symptoms of pneumonia, the staff at the nursing home would obtain chest x-rays using a mobile unit, according to the team's report in this week's Journal of the American Medical Association.

If following the new guideline, the nurse would determine if the patient could eat and drink, had a pulse of no more than 100 beats per minute, respiratory rate of less than 30 per minute, a lower blood pressure reading of 90 or higher, and oxygen levels in the blood at least 92 per cent of maximum.

If any one of those five conditions were not met, the decision tree stipulated that the patient be transferred to a hospital.

''With those symptoms, some could be in septic shock and for those residents, hospital transfer would be appropriate,'' Loeb told Reuters Health. ''We certainly did not want to promote unnecessary hospitalization, but there are circumstances where it is warranted.'' Otherwise, the patient remained in the nursing home, and was treated there.

The study included 327 patients in the guidelines group and 353 in the usual care group. Thirty-four residents (10 per cent) and 76 (22 per cent) in the two groups, respectively, were hospitalized.

The mortality rates were similar between groups (8 per cent versus 9 per cent).

At the end of the study, ''we did formal interviews to assess their responses to the treatment they received, and the patients and their families preferred that they be treated in the nursing home,'' Loeb said.

Cost analysis showed, on average, that ''for each Ontario resident treated with the clinical pathway, there were cost savings of US 1016 dollars,'' Loeb continued.

''The cost savings were higher (US 1517 dollars) when we calculated it sing costs that residents in the US would incur,'' he added. ''We also estimated that implementation of the pathway could lead to a cost savings of US 70 million dollars for Canada annually and 831 million dollars per year in the US.'' His group's next steps will be ''to evaluate how this research is translated in practice - i.e., the impact when it is rolled out in the real world.'' REUTERS PR RAI0851