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Study Examines Delays in Initiating Antibiotic Therapy for Veterans Hospitalized with Pneumonia


Studies have shown that 'time to first antibiotic dose' (TFAD) for patients hospitalized with community-acquired pneumonia can significantly affect mortality and length of hospital stay, thus TFAD is an important quality indicator for pneumonia care. Current guidelines require an emergency department (ED) diagnosis of pneumonia with chest X-ray confirmation, as well as antibiotic therapy as soon as possible after an appropriately established diagnosis. The goals of this study were to: 1) delineate the basic steps in the flow of patient care from presentation in the ED to TFAD; 2) identify perceived barriers to and facilitators of reduced TFAD; 3) describe quality improvement strategies undertaken to improve TFAD rates; and 4) identify perceived strategies for facilities to enhance performance on this national quality measure. Investigators analyzed data from 10 lower- and 10 higher-performing VA hospitals. Survey and focus group participants from each site included: an ED physician, ED nurse, radiologist, pharmacist, and quality manager. The web-based survey and telephone-based focus group questions assessed for this study focused on perceived barriers to and facilitators of reduced TFAD.

Findings show that of the 82 survey participants, 72% perceived that ordering and performing chest X-ray was the most frequent step resulting in TFAD delays. Additional steps reported to cause TFAD delays were medical provider assessment, chest X-ray interpretation, ordering/obtaining blood cultures, and ordering/administering initial antibiotic therapy. The most commonly perceived barriers were patient and X-ray equipment transportation delays and communication delays between providers. The most frequently used strategies to reduce TFAD were stocking antibiotics in the ED and physician education. Focus groups emphasized the importance of multi-faceted quality improvement approaches and a top-down hospital leadership style to improve performance on this pneumonia quality measure.

PubMed Logo Rodriguez K, Burkitt K, Sevick M, et al. Assessment of processes of care to promote timely initiation of antibiotic therapy for patients with pneumonia hospitalized from the emergency department. The Joint Commission Journal on Quality and Patient Safety October 2009;35(10):509-18.

This study was funded by VA's Office of Quality and Performance and by HSR&D. All authors are part of HSR&D's Center for Health Equity Research and Promotion, Pittsburgh.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.