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Door-to-antibiotic time for pneumonia in a rural emergency department

Published online by Cambridge University Press:  21 May 2015

Danielle Anstett ,
Audra Smallfield ,
Dean Vlahaki  and
W. Ken Milne
Danielle Anstett
Affiliation:
Department of Medicine, National University of Ireland, Galway, Ireland
Audra Smallfield
Affiliation:
Department of Medicine and Dentistry, University of Western Ontario, London, Ont.
Dean Vlahaki
Affiliation:
Department of Medicine, University of Queensland, Brisbane, Australia
W. Ken Milne*
Affiliation:
Department of Family Medicine, Faculty of Medicine and Dentistry, University of Western Ontario, London, Ont.
*
South Huron Hospital, 24 Huron St. W., Exeter ON N0M 1S2; monycon@hurontel.on.ca

Abstract

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Objective:

The Joint Commission on Accreditation of Healthcare Organizations recommends that patients admitted to hospital with pneumonia receive their first dose of antibiotics within 6 hours of presenting to the emergency department (ED). Previous research in the United States indicates that rural hospitals may be better at achieving this benchmark than urban centres. This particular quality indicator has not yet been evaluated in Canada. The purpose of this study was to determine whether the target door-to-antibiotic (DTA) time of 6 hours or less could be met in a rural ED.

Methods:

We conducted a retrospective chart review of patients admitted to hospital with a diagnosis of pneumonia. Descriptive data for each case was collected, including demographic and timeline information. We analyzed DTA time, antibiotic type, route of administration, hospital length of stay and disposition at discharge.

Results:

We reviewed a total of 320 charts from Apr. 1, 2003, to Mar. 31, 2008. The final sample consisted of 143 patients (50.3% women) whose median age was 79 years. The median DTA time was 151 minutes and 81.8% of patients received their first dose of antibiotics within 6 hours. Patients received antibiotics either orally (47.6%), intravenously (47.6%) or both (4.8%). Single-agent respiratory fluoroquinolones were used 71.4% of the time. Median length of hospital stay was 4 days; most patients were discharged home (79.7%), 11 died, 11 were transferred and 7 were discharged to a nursing home.

Conclusion:

A DTA time of 6 hours or less is achievable in a rural ED.

Keywords

community-acquired pneumoniarural EDdoor-to-antibiotic time
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 3 , May 2010 , pp. 207 - 211
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

References

REFERENCES

1.Canadian Institute for Health Information. Respiratory diseases in Canada. Ottawa (ON): The Institute; 2001. Available:http//www.phac-aspc.gc.ca/publicat/rdc-mrc01/pdf/rdc0901e.pdf (accessed 2009Jan. 19).Google Scholar
2.Seymann, GB. Community-acquired pneumonia: defining quality care. J Hosp Med 2006;1:344–53.CrossRefGoogle ScholarPubMed
3.Houck, PM, Bratzler, DW, Nsa, W, et al.Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med 2004;164:637–44.CrossRefGoogle ScholarPubMed
4.Meehan, TP, Fine, MJ, Krumholz, HM, et al.Quality of care, process, and outcomes in elderly patients with pneumonia. JAMA 1997;278:2080–4.CrossRefGoogle ScholarPubMed
5.Battleman, DS, Callahan, M, Thaler, HT. Rapid antibiotic delivery and appropriate antibiotic selection reduce length of hospital stay of patients with community-acquired pneumonia: link between quality of care and resource utilization. Arch Intern Med 2002;162:682–8.Google Scholar
6.Specifications manual for national hospital quality measures, version 2.3. Oakbrook Terrace (IL): The Joint Commission/Centers for Medicare & Medicaid Services; 2007. File 2zb_PN5abc.pdf. Available:http//www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier3&cid=1163010419895(accessed 2009 Jan. 19).Google Scholar
7.Ziss, DR, Stowers, A, Field, C. Community-acquired pneumonia: compliance with centers for Medicare and Medicaid services, national guidelines, and factors associated with outcome. South Med J 2003;96:949–59.CrossRefGoogle ScholarPubMed
8.Beneson, R, Magalski, A, Cavanaugh, S, et al.Effects of a pneumonia clinical pathway on time to antibiotic treatment, length of stay, and mortality. Acad Emerg Med 1999;6:1243–8.Google Scholar
9.Lutfiyya, MN, Bhat, DK, Gandhi, SR, et al.A comparison of quality of care indicators in urban acute care hospitals and rural critical access hospitals in the United States. Int J Qual Health Care 2007;19:141–9.Google Scholar
10.Gilbert, EH, Lowenstein, SR, Koziol-McLain, J, et al.Chart reviews in emergency medicine research: Where are the methods? Ann Emerg Med 1996 ;27:305–8.Google Scholar
11.Beveridge, R, Clarke, B, Janes, L, et al.Canadian Emergency Department Triage and Acuity Scale: implementation guidelines. CJEM 1999;1:S3–S32.Google Scholar
12.Vlahaki, D, Milne, WK. Rural hospital CTAS times [abstract]. CJEM 2007;9:207.Google Scholar
13.Canadian Institute for Health Information. Understanding emergency department wait times. Who is using the emergency department and how long are they waiting? Ottawa (ON): The Institute; 2005.Google Scholar
14.Mandell, LA, Thomas, JM, Grossman, RF, et al.Summary of Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Disease Society and the Canadian Thoracic Society. Can J Infect Dis 2000;11:237–48.Google ScholarPubMed
15.Mandell, LA, Marrie, TJ, Grossman, RF, et al.Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society. Clin Infect Dis 2000;31:383–421.CrossRefGoogle ScholarPubMed
16.Canadian Institute for Health Information. DAD resource intensity weights and expected length of stay for CMG. Ottawa(ON): The Institute; 2005.Google Scholar