1. Jennifer Mah, MD March 2016

2.  Community acquired pneumonia is often suspected from clinical symptoms and physical exam  Diagnosis is confirmed on CXR  Sputum cultures have low clinical utility ◦ Diagnostic yield ranges from 54-86%

4.  Chart review of 15 patients on Team G during March 2016 ◦ Admitting diagnosis ◦ Sputum culture ordered? ◦ Appropriate use of sputum culture?

5.  Sepsis due to: ◦ UTI ◦ Pyelonephritis  Infection w/o SIRS ◦ Cellulitis ◦ Bilateral foot ulcers  Other ◦ RAI for thyroid cancer ◦ Spinal mass ◦ Intractable chronic pain Admitting DxPatients Sepsis2 Infection w/o SIRS2 GI bleed2 Abdominal pain4 Chest pain2 Other5

6.  1 sputum culture ordered out of 15 patients ◦ Infectious diagnosis: 1 of 4 (25%) ◦ Sepsis: 1 of 2 (50%)  Appropriate? ◦ Of 2 patients admitted with sepsis, guidelines were followed for 1 patient ◦ The 1 sputum culture was ordered inappropriately

7.  UTI ◦ CC: nausea and vomiting ◦ CXR unremarkable ◦ Sputum culture ordered inappropriately as part of sepsis workup  Pyelonephritis ◦ CC: abdominal pain ◦ CXR unremarkable  CTA negative for PE, also no evidence of pneumonia ◦ Sputum culture not ordered, appropriately

8.  If each sputum culture costs $136, then our 1 inappropriate test was $136 wasted  However this was a limited sample size  There were also no admissions for pneumonia  Appropriate ordering of diagnostic tests based on guidelines can improve cost consciousness care

9.  Bartlett, JG. Diagnostic approach to community- acquired pneumonia in adults. UpToDate. 27 Dec 2015. Web. 14 Mar 2016.  Happy Hospitalist. “Prices should be readily available to save hospitals money.” KevinMD.com. 9 Jun 2011. Web. 12 Mar 2016.  Mandell, LA, et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community- Acquired Pneumonia in Adults. Clin Infect Dis. (2007) 44 (Supplement 2): S27-S72.