CURB 65

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CURB 65 was utilized by Nathan C. Dean, MD, of LDS Hospital in Salt Lake City, UT, when creating a pneumonia pathway about 10 years ago. To begin the pathway development process it was important to show everyone the results and display the variances in quality of care among the IHC hospitals and within departments. This caused enthusiasm to create a guideline and to follow a few key steps, which ultimately led to a reduction in the need to micromanage the process.

One key step in constructing the pneumonia pathway was the development of a screening process called CURB 65, a severity-scoring system for pneumonia. In a European study by the British Thoracic Society, four variables reflecting acute pneumonia-associated morbidity were shown to be predictive of death from pneumonia: the presence of confusion (C) and blood urea nitrogen (U), respiratory rate (R), and blood pressure (B) at defined thresholds. This scale helps determine whether the patient goes to the a hospital floor, the ICU or is discharged out of the ER. For patients admitted to the floor, the recommendation is doxycyclin and ceftriaxone (Rocephin) as the default, with levofloxacin as an alternative in case of allergies. In the ICU, patients get intravenous azithromycin and intravenous ceftriaxone. CURB 65 screening is an objective method for physicians to determine the appropriate antibiotic and the level care for patients presenting with pneumonia. Some modifications to the CURB 65 screening have also provided for estimating length of stay.

Guidelines can assist caregivers in more consistently matching a patient’s required level of care with the most appropriate nursing floor. As such, guidelines can go a long way ensuring that patients receive the optimum level of care. Efficiently matching the resources available to provide care with the patient demand for care can have a dramatic impact on productivity and quality through a hospital’s system.

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