Dr Victoria Madigan1,2, Elizabeth Kindred1, Melissa Sajeva1, Dr Dorothy Ling1
1Northern Health, Epping, Australia, 2St Vincent's Health, Melbourne, Australia
Biography:
Dr Victoria Madigan is an Infectious Diseases Physician at Northern Health and Medical Microbiologist at St Vincent's Hospital, Melbourne.
Abstract:
Introduction
Healthcare-associated pneumonia (HAP) is a common cause of healthcare-associated infection (HAI). The Australian Commission for Safety and Quality in Healthcare (ACSQHS) recommends monitoring healthcare-associated complications (HACs), including HAP, using hospital coding. In August, 2023, an electronic medical record (EMR), was implemented at Northern Health. Reductions in HAC incidence were observed after implementation. This study explores the impact of EMR implementation on HACS, particularly HAP.
Methods
Hospital admissions from pre-EMR (January to April, 2023) and post-EMR (January to April, 2024) periods were compared for differences in overall HAC and pneumonia HAC incidences. Episodes of pneumonia HAC were reviewed to determine if cases met European Centre for Disease Control (ECDC) criteria for HAP. Other data collected included demographics, treatment, risk factors and alternative diagnoses.
Results
There was a 25% difference in overall HAC incidence between pre-EMR and post-EMR periods (IRR: 1.34, P <0.0001). A reduction was also noted for pneumonia (29.8 vs 19.0 cases/10,000 separations, IRR 1.57, P = 0.0078). The proportion of cases coded as a HAC that met ECDC criteria for HAP remained low in both periods (9 cases, 10.6% vs 8 cases, 14.0%). Patients in both periods were similar in demographics and other factors. Antibiotics were used to treat HAP episodes for 97.1% of episodes.
Conclusion
The implementation of EMR reduced HAC coding of pneumonia but not the true incidence of nvHAP. Efforts to reduce pneumonia HACs must target clinicians with the aim of improving their understanding of nvHAP diagnosis, documentation and risks associated with overprescribing of antibiotics.