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Open Access Research article

Which patients with lower respiratory tract infections need inpatient treatment? Perceptions of physicians, nurses, patients and relatives

Claudia Baehni1, Sabine Meier1, Pamela Spreiter1, Ursula Schild1, Katharina Regez1, Rita Bossart1, Robert Thomann1, Claudine Falconnier1, Mirjam Christ-Crain1, Sabina De Geest3, Beat Müller2*, Philipp Schuetz1 and the ProHOSP study group

Author Affiliations

1 Department of Internal Medicine, University Hospital Basel, Basel, Switzerland

2 Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland

3 Institute of Nursing Science, University of Basel, Basel, Switzerland

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BMC Pulmonary Medicine 2010, 10:12  doi:10.1186/1471-2466-10-12

Published: 11 March 2010

Abstract

Background

Despite recommendations for outpatient management, low risk patients with lower respiratory tract infections (LRTIs) are often hospitalized. This survey analyzed perceptions of physicians, nurses, patients and relatives about feasibility of outpatient management and required duration of hospital stay.

Methods

We performed a prospective, observational questionnaire survey in hospitalized patients with LRTI as part of a multicenter trial. Treating physicians and nurses, patients and their relatives were asked on admission and before discharge about feasibility of outpatient treatment over 5 dimensions (medical, nursing, organizational factors, and patients' and relatives' preferences) using continuous scales.

Results

On admission, 12.6% of physicians, 15.1% of nurses, 18.0% of patients and 5.2% of relatives believed that outpatient treatment would be possible. Before hospital discharge, 31.1% of physicians, 32.2% of nurses, 11.6% of patients and 4.1% of relatives thought that earlier discharge would have been feasible. Medical factors were the most frequently perceived motives for inpatient management. These perceptions were similar in all LRTI subgroups and independent of disease severity and associated expected mortality risks as assessed by the Pneumonia Severity Index (PSI).

Conclusion

Independent of type and severity of respiratory tract infection, the misperceived high severity and expected mortality and morbidity were the predominant reasons why treating physicians, nurses, patients and their relatives unanimously believed that inpatient management was necessary. Better assessment and communication about true expected medical risks might contribute to a pathway to shorten in-hospital days and to introduce a more risk-targeted and individually tailored allocation of health-care resources.

Trial Registration

NCT00350987