The utility of an in-hospital observation period after discontinuing intravenous antibiotics

PURPOSE: To determine whether observing patients overnight in the hospital after intravenous antibiotics have been discontinued is a useful way to ide ntify important clinical events. SUBJECTS AND METHODS: We performed a retrospective chart review of patients admitted during a 6-month period to a tertiary care teaching hospital with a primary diagnosis of either pneumonia, urinary tract infection, or cellu litis who were treated with intravenous antibiotics. Charts were abstracted for patient characteristics, including comorbid illnesses and laboratory v alues, as well as for evidence of recurrent infection or other adverse even ts. RESULTS: Of the 374 patients in the study, 63 (17%) were discharged on the day intravenous antibiotics were discontinued. These patients were 10 years younger (P = 0.0009) and had fewer comorbid illnesses (P = 0.02) than thos e who were observed in the hospital. Recurrent infection was noted in 3 (1% ; 95% confidence interval 0.2% to 3%) of the 308 patients who were observed . A mild adverse antibiotic reaction was also noted in three observed patie nts. The readmission rate to the same institution for recurrent infection w as 3% for patients with an observation period and 2% for patients without a n observation period (P = 0.70). CONCLUSIONS: Observing patients overnight in the hospital after discontinui ng intravenous antibiotics is a common clinical practice. There was an extr emely low incidence of adverse events during the observation period, and th e events that did occur would have been discovered in an outpatient setting , In-hospital observation after discontinuing intravenous antibiotics is un necessary for most patients with pneumonia, urinary tract infection, or cel lulitis and greatly increases health-care costs. Am J Med. 1999;106:6-10. ( C) 1999 by Excerpta Medica, Inc.