| Abstract |
Introduction: According to current guidelines, the treatment of patients with community-acquired pneumonia should be based on scoring systems like the Pneumonia severity assessment scale (Pneumonia Severity Index - PSI). Patients classified as PSI III are a borderline group and their short term observation in hospital is recommended. However, this leads to the use of hospital resources that could be avoided since many of these patients do not need hospitalization. Purpose: The purpose of this study was to evaluate the safety and applicability of an android application for the remote/home monitoring of PSI class III pneumonia patients by ED staff. Methods. 15 consecutive patients with PSI class III pneumonia, admitted to the University Hospital of Heraklion ED short term care unit, were asked to use a tablet-based application designed to inform physicians for patient’s pulse oximetry, temperature, heart and respiratory rate. The study did not include any other intervention. The physicians acted completely independently and decided based on their own clinical assessment whether the patient would be admitted to a clinic or discharged. Physicians and nurses of short term care unit were asked to evaluate patient safety if the whole process had taken place at the patients’ home. Results: Fifteen patients with PSI class III lobar pneumonia were recruited during the study period (8 women, 7 men), with an average age of 74.1 years (range 55-87). During admission all patients had SatO2> 91%. All patients had arterial blood gasses measured with mean values pO2 67.5 mmHg (62-77) and pCO2 35.6 mmHg (26-44) with respiratory alkalosis in 11 cases (73%). Patients’ average white blood cells (WBC) were 8,870 K / μl (77% neutrophils) and no patients had acute kidney injury, glucose above 200 mg / dL, or increased lactic acid levels. During their stay at the short term care unit, all patients received antibiotics and 9 patients received nebulized ipratropium/salbutamol and/or inhaled corticosteroids. All patients registered in the application 1 to 3 measurements of pulse oximetry, heart rate, temperature and respiratory rate, although 12 patients reported that they asked a family member to help them. At the end of the observation period, 3 patients were admitted and 12 were discharged. Physicians and nursing staff who were responsible for patients’ observation estimated that, 13 cases could be safely monitored by their home, as 2 patients (both discharged) were considered unreliable and this practice would not be safshort term care unit and 2,730 Euros of insurance funds could be saved with absolute safety. Conclusion: A simple tablet or smartphone android application accompanied by a pulse oximeter and a thermometer can be used safely for the remote monitoring of patients with community acquired pneumonia PSI class III as an alternative to ED short term care unit admission. Such applications may help in the protection of hospital resources and the decrease of healthcare costs.
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Εικονική εκτίμηση της δυνατότητας για κατ οίκον νοσηλεία ασθενών με πνευμονία κοινότητας (PORT Risk Class III) με την χρήση ηλεκτρονικής πλατφόρμας επικοινωνίας με τοπικό τμήμα επειγόντων περιστατικών
