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Introduction: ePNa open loop, electronic clinical decision support improved mortality and disposition for emergency department (ED) community-acquired pneumonia patients in 4 intervention hospitals vs 3 usual care hospitals (Annals EM 2015 66:511). ePNa provides ED clinicians with support for diagnosis and objective severity measurement, then disposition and antibiotic recommendations based on the DRIP score. We rolled out ePNa across 16 additional Intermountain Healthcare (Utah, USA) Hospitals beginning 2018 in a stepwise implementation trial. Objectives: Evaluate whether ePNa might improve clinical outcomes in a diverse group of non-teaching hospitals. Methods: 7293 ED patients >18 years 2017 to 2019 with complete data were identified electronically by ICD-10 codes; patients without confirmatory chest imaging (CheXED, Stanford AI model) were excluded. Results: Median age was 67 (IQR 52-79) years, 48% female. ePNa: use by clinicians averaged 47.4% after rollout but varied from 10% to 92% by month and hospital. Intention to treat analysis showed 30-day mortality of 5% (146/3101) vs 10% (417/4192) before rollout; outpatient disposition increased from 21% vs 48%. 7-day secondary hospitalization was 1% vs 3% after rollout. 30-day all-cause mortality was significantly lower after severity adjustment (electronicCURB, age, PaO2/FiO2, pleural effusion, HCAP, gender) by logistic regression (OR 0.57, 95% CI 0.46,0.69, p Conclusions: Rollout of ePNa clinical decision support into 16 hospital ED was associated with decreased mortality and hospital admission among pneumonia patients. We plan further interventions to increase ePNa use by ED clinicians.

A real-time electronic CDS for pneumonia (ePNa) identifies possible pneumonia patients, measures severity and antimicrobial resistance risk, and then recommends disposition, antibiotics, and microbiology studies. Use is voluntary, and clinicians may modify treatment recommendations. ePNa was associated with lower mortality in emergency department (ED) patients versus usual care (Annals EM 66:511). We adapted ePNa for the Cerner EHR, and implemented it across Intermountain Healthcare EDs (Utah, USA) throughout 2018. We introduced ePNa through didactic, interactive presentations to ED clinicians; follow-up visits identified barriers and facilitators to use. Email reminded clinicians and answered questions. Hospital admitting clinicians encouraged ePNa use to smooth care transitions. Audit-and-feedback measured utilization, showing variations from best practice when ePNa and associated electronic order sets were not used. Use was initially low, but gradually increased especially at larger hospitals. A user-friendly interface, frequent reminders, audit-and- feedback, a user survey, a nurse educator, and local physician champions are additive towards implementation success.