Background: Community acquired pneumonia (CAP) is a key clinical focus area of Advancing Quality (AQ), a programme which has shown to decrease mortality with significant financial gain for North West Hospitals (ref: N Engl J Med 2012; 367:1821-8, Health Econ. (2013)DOI: 10.1002/hec). A dedicated AQ pneumonia lead nurse relies on coding system for case identification but current codes fail to differentiate CAP from other causes of pneumonia.
Aims and Objectives: To find out the number of patients who had CAP amongst cases coded as Pneumonia specified (organism known) and non-specified (organism unknown).
Methods: A prospective data was collected for patients coded as pneumonia specified and non-specified over 3 months period (n=250). A thorough review of medical notes, discharge summaries and investigation results for the admission episode was undertaken to identify actual number of CAP cases.
Results: Out of the 250 cases reviewed only 70% had CAP, while 12.4% had pneumonia due to other cause. Moreover, 17.6% (44) were miscoded as pneumonia, the most common being sepsis with other or unknown source followed by exacerbation of COPD.
Conclusion: Though majority of the patients coded as pneumonia had CAP, a significant proportion had other diagnosis. Current coding system categorises pneumonia based on isolation of a causative organism but fail to specifically differentiate between its clinical forms. Also, it is not infrequent to find other conditions being miscoded as pneumonia. We suggest a revised coding for different pneumonias to reflect clinical rather than theoretically significant differences between diseases.