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.
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.