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A critical pathway reduced resource use without compromising safety and effectiveness in community acquired pneumonia

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 QUESTION: In patients with community acquired pneumonia (CAP), does a critical pathway reduce the use of resources without compromising safety and effectiveness?


Randomised (cluster randomisation), blinded (outcome assessor),* controlled trial with 6 week follow up.


20 teaching or community hospitals in Canada.


1743 patients who had ≥2 signs or symptoms of CAP (eg, temperature >38°C, productive cough, chest pain, shortness of breath, and crackles on auscultation) and opaque findings on chest radiography that were consistent with the presence of acute pneumonia. Exclusion criteria included HIV infection; use of prednisone, >10 mg/day, or other immunosuppressive agents; treatment for cancer; history of organ transplantation; active tuberculosis; or cystic fibrosis. Patients in 19 of 20 hospitals were evaluated.


After stratification by type of institution, hospitals were matched by historical length of stay and allocated to a critical pathway (n=10) or to …

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  • Sources of funding: Janssen-Ortho Inc and Medical Research Council of Canada–Pharmaceutical Manufacturers' Association of Canada Awards Program.

  • For correspondence: Dr B G Feagan, London Clinical Trials Research Group, John P Robarts Research Institute, 100 Perth Drive, London, Ontario N6A 5K8, Canada. Fax +1 519 663 3807.

  • * See glossary.