Algorithm for Success


The use of a procalcitonin (PCT) algorithm reduced the usage of antibiotics in patients with lower-respiratory-tract infections (LTRI), according to a recent study that may highlight a new way for hospitalists to reduce costs.

The study found the mean duration of antibiotics exposure in the PCT group was lower than in a control group (5.7 days vs. 8.7 days). The researchers, who studied 1,359 patients at six tertiary-care hospitals in Switzerland, also reported less-frequent antibiotic-associated adverse effects, such as nausea, rashes or diarrhea, in the PCT group (JAMA. 2009;302(10):1059-1066).

Scott Flanders, MD, FHM, SHM president and director of the hospitalist program at the University of Michigan Health System in Ann Arbor, says if further review were to show more statistical impacts on costs savings, PCT usage would become more common.

"If you can reduce length-of-stay by half through treatment intervention, then this will easily pay for itself," says Dr. Flanders, who adds, "Hospitalists need to know and have at their fingertips the best avenues of treatment."

Devendra Amin, MD, director of critical-care services at Morton Plant Hospital in Clearwater, Fla., was one of the first physicians to use PCT tests after the Food and Drug Administration (FDA) approved wider usage last year. He says the overuse of antibiotics is a needless cost overrun that hospitalists using PCT tests could better control—and then tout as an example of their ability to reduce costs. Dr. Amin plans to team with a half-dozen of his health system's hospitalists next year to work on a study of the effectiveness of PCT in a community hospital setting.

"If everything else fits, it's another piece of information that's important to the puzzle," Dr. Amin says. "No single test in isolation is going to give you everything you want … but this can help."

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