SHM Converge Scientific Abstract ePoster Gallery-Diagnostic Momentum in Hospitalized Patients With Pneumonia and Uti

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This retrospective cohort study examined diagnostic momentum in 68 Michigan hospitals for two common infections: community-acquired pneumonia (CAP) and urinary tract infection (UTI). Diagnostic momentum means a diagnosis made in the emergency department is continued by the inpatient team, even when the diagnosis is likely incorrect.<br /><br />Using medical record review, researchers identified inappropriately diagnosed CAP and UTI cases from 2018–2023. CAP was considered inappropriate if patients did not meet diagnostic criteria; UTI was considered inappropriate if symptoms or signs of UTI were absent. The main outcome was whether patients received at least 3 days of antibiotics, indicating diagnostic momentum.<br /><br />Among 40,212 patients treated for CAP and 32,402 treated for UTI, 11.8% of CAP cases and 18.5% of UTI cases were inappropriately diagnosed in the ED. Among those started on antibiotics in the ED, diagnostic momentum was very common: 90.1% for CAP and 82.1% for UTI. Diagnostic momentum was somewhat correlated across conditions (Pearson r = 0.127), meaning hospitals prone to momentum for one condition tended to be prone for the other as well.<br /><br />Patient factors associated with more diagnostic momentum included sepsis, altered mental status, and COPD. Hospital factors also mattered: non-academic, smaller, and rural hospitals had more diagnostic momentum, while hospitals with more resources had less. However, no specific antibiotic stewardship interventions were linked to lower diagnostic momentum.<br /><br />Overall, the study found that diagnostic momentum is widespread in hospitalized patients with CAP and UTI, suggesting that new strategies are needed to help inpatient teams reassess ED diagnoses and reduce unnecessary antibiotic use.

Asset Subtitle

Timothy Brash

Meta Tag

Author List Anurag N. Malani, Ashwin B. Gupta, Danielle Osterholzer, David Ratz, Elizabeth McLaughlin, Jennifer K. Horowitz, Jonathan Sawicki, Keith Kocher, Lindsay A. Petty, Michael Pulia, Scott A. Flanders, Tejal N. Gandhi, Timothy Brash, Valerie M. Vaughn

Category Research

Concept Diagnostic Momentum

Concept Community-Acquired Pneumonia

Concept Urinary Tract Infection

Concept Primary Outcome Measure

Concept Antibiotic Duration

Distinguished Finalist

Presenter Organization University of Utah

Presenting Author Timothy Brash

Track Quality Improvement

Keywords

diagnostic momentum

community-acquired pneumonia

urinary tract infection

antibiotic stewardship

emergency department diagnosis

hospital retrospective cohort

inappropriate diagnosis

inpatient antibiotic use

Michigan hospitals

unnecessary antibiotic use

Diagnostic Momentum

Community-Acquired Pneumonia

Urinary Tract Infection

Primary Outcome Measure

Antibiotic Duration