Community acquired pneumonia (CAP) is a key clinical focus area of Advancing Quality (AQ), a programme which has shown to decrease mortality with significant financial gain for North West Hospitals (ref: N Engl J Med 2012; 367:1821-8, Health Econ.
Background: Community acquired pneumonia (CAP) is a key clinical focus area of Advancing Quality (AQ), a programme which has shown to decrease mortality with significant financial gain for North West Hospitals (ref: N Engl J Med 2012; 367:1821-8, Health Econ. (2013)DOI: 10.1002/hec). A dedicated AQ pneumonia lead nurse relies on coding system for case identification but current codes fail to differentiate CAP from other causes of pneumonia.
Aims and Objectives: To find out the number of patients who had CAP amongst cases coded as Pneumonia specified (organism known) and non-specified (organism unknown).
Methods: A prospective data was collected for patients coded as pneumonia specified and non-specified over 3 months period (n=250). A thorough review of medical notes, discharge summaries and investigation results for the admission episode was undertaken to identify actual number of CAP cases.
Results: Out of the 250 cases reviewed only 70% had CAP, while 12.4% had pneumonia due to other cause. Moreover, 17.6% (44) were miscoded as pneumonia, the most common being sepsis with other or unknown source followed by exacerbation of COPD.
Conclusion: Though majority of the patients coded as pneumonia had CAP, a significant proportion had other diagnosis. Current coding system categorises pneumonia based on isolation of a causative organism but fail to specifically differentiate between its clinical forms. Also, it is not infrequent to find other conditions being miscoded as pneumonia. We suggest a revised coding for different pneumonias to reflect clinical rather than theoretically significant differences between diseases.
Patrick McDermott, Kanwal Tariq, Julia Harrington, Hassan Burhan and Andrea Collins
Respiratory Medicine, The Royal Liverpool and Broadgreen University Hospitals, Liverpool, United Kingdom