Document Detail

Systematic delays in antibiotic administration in the emergency department for adult patients admitted with pneumonia.
MedLine Citation:
PMID:  16825671     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The authors sought to determine the contribution of delays in care on time to antibiotics for patients admitted from the emergency department (ED) with pneumonia and to identify patients at risk for delayed antibiotics. METHODS: This was a retrospective cohort study of patients admitted to the Hospital of the University of Pennsylvania (HUP) and to Pennsylvania Presbyterian Hospital (Presbyterian) with an admission diagnosis of pneumonia in 2004. RESULTS: A total of 393 patients were included. Ninety percent had antibiotics documented as given in the ED. Eighty-three (43%) of 209 at HUP and 104 (64%) of 161 patients at Presbyterian received antibiotics within four hours. Patients who received antibiotics more than four hours after ED arrival experienced longer waits for radiograph orders (HUP, 54 min [95% confidence interval {CI} = 33 to 76 min]; Presbyterian, 43 min [95% CI = 29 to 58 min]), for radiograph performance (HUP, 21 min [95% CI = 4 to 39 min], Presbyterian, 24 min [95% CI = 8 to 47 min]), for antibiotic orders (HUP, 56 min [95% CI = 38 to 95 min]; Presbyterian, 67 min [95% CI = 33 to 103 min]), and for antibiotic administration (HUP, 28 min [95% CI = 17 to 39 min]; Presbyterian, 30 min [95% CI = 21 to 38 min]). Patients with lower severity scores (p = 0.005) and patients with nonclassic clinical presentations for pneumonia were at increased risk for delayed antibiotics (odds ratio, 2.2; 95% CI = 1.1 to 4.4). CONCLUSIONS: Antibiotic delays for patients admitted with pneumonia occur across multiple care processes. Less severely ill patients and patients with nonclassic presentations are at higher risk for delayed antibiotic administration. Hospitals should consider performing a similar analysis to evaluate hospital-specific and patient-specific care delays.
Jesse M Pines; Melinda J Morton; Elizabeth M Datner; Judd E Hollander
Publication Detail:
Type:  Journal Article     Date:  2006-07-06
Journal Detail:
Title:  Academic emergency medicine : official journal of the Society for Academic Emergency Medicine     Volume:  13     ISSN:  1553-2712     ISO Abbreviation:  Acad Emerg Med     Publication Date:  2006 Sep 
Date Detail:
Created Date:  2006-09-01     Completed Date:  2006-11-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9418450     Medline TA:  Acad Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  939-45     Citation Subset:  IM    
Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
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MeSH Terms
Anti-Bacterial Agents / therapeutic use*
Cohort Studies
Drug Utilization Review
Emergency Service, Hospital / statistics & numerical data*
Middle Aged
Pneumonia / drug therapy*,  radiography
Quality Assurance, Health Care
Retrospective Studies
Risk Factors
Time Factors
Reg. No./Substance:
0/Anti-Bacterial Agents

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