Pneumonia Misdiagnosis on Readmission Frequent, Costly

Roxanna Guilford-Blake, for HealthLeaders Media, October 28, 2010

These studies indicate a need to increase awareness among physicians about using the diagnostic standards and criteria set forth in the Centers for Disease Control and Prevention's National Healthcare Safety Network for diagnosing pneumonia at the time of readmission, says Hiren Pokharna, MD, a fellow at Henry Ford Hospital and the lead author of the studies.

Physicians need to be open to other diagnoses—especially once the patient is admitted, he says. Those who indeed had pneumonia were more likely to have a fever and altered mental status, he pointed out.

The patient is often diagnosed with pneumonia and started on antibiotics in the emergency department. (The research found that 76 percent of the diagnoses—accurate and otherwise—were made there.) Failure to overrule this diagnosis after readmission is the problem, he explains, noting the patient may be diagnosed with pneumonia in the emergency department, but that doesn't mean it should remain the final diagnosis—especially because COPD and chronic bronchitis, among other conditions, can mimic pneumonia.

"Pneumonia is a diagnosis of ease." It's up to the doctor who sees the patient on the floor to change the diagnosis if appropriate, Pokharna says. "Be vigilant over the next few days." Consider other diagnoses. "Keep an open mind."

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