Effect of emergency department crowding on time to antibiotics in patients admitted with community-acquired pneumonia
Effect of emergency department crowding on time to antibiotics in patients admitted with community-acquired pneumonia
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DOI：
10.1016/j.annemergmed.2007.08.003
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发表时间：
2007-11-01
影响因子：
6.2
通讯作者：
Bacchetti, Peter
中科院分区：
文献类型：
--
作者：
Fee, Christopher;Weber, Ellen J.;Bacchetti, Peter
研究目的：我们假设急诊科(ED)的数量和患者复杂性的增加与较低的护理质量有关，以社区获得性肺炎患者使用抗生素的时间来衡量。2004年1月至2005年6月期间从急诊科入院并出院的社区获得性肺炎患者，由我们机构为联合委员会的抗生素时机核心措施进行审查。提取了患者的年龄、性别、种族、运输方式、到达时间、分诊敏锐度、住院护理水平和到达使用抗生素的时间的医疗记录。控制患者特征，多因素Logistic回归分析确定了抵达后4小时内使用抗生素与社区获得性肺炎患者到达时ED总量、抵达时需要入院的ED患者数量之间的关系。结果：486名患者符合研究条件；抗生素使用时间为405。61%的患者在4小时内接受了抗生素治疗。急诊室患者越多(优势比0.96/新增患者；95%可信区间0.93-0.99)，最终入院患者越多(优势比0.93/患者；95%可信区间0.88-0.99)，4小时内使用抗生素的可能性就越小。结论：随着ED容量的增加，合并社区获得性肺炎的ED患者不太可能得到及时的抗生素治疗。即使在容量低于最大床位容量的情况下，额外病人的影响似乎也会发生。为确保教育署达到质素目标而采取的措施，应考虑教育署数量的影响。
Study objective: We hypothesize that emergency department (ED) volume and increased patient complexity are associated with lower quality of care, as measured by time to antibiotics for patients being admitted with community-acquired pneumonia.Methods: This was a cross-sectional study at a university tertiary care hospital ED. Community-acquired pneumonia patients admitted from the ED and discharged between January 2004 and June 2005 were reviewed by our institution for The Joint Commission's antibiotic timing core measure. Medical records were abstracted for patient age, sex, race, mode of transport, arrival time, triage acuity, inpatient level of care, and arrival-to-antibiotic-administration times. Controlling for patient characteristics, multivariate logistic regression determined association of antibiotic administration within 4 hours of arrival, with total ED volume at the time of the community-acquired pneumonia patient's arrival, and with number of ED patients requiring admission at the time of arrival.Results: Four hundred eighty-six patients were eligible for the study; antibiotic administration time was available for 405. Sixty-one percent of patients received antibiotics within 4 hours. Antibiotic administration within 4 hours was less likely with a greater number of patients (odds ratio 0.96 per additional patient; 95% confidence interval 0.93 to 0.99) and a greater number of patients ultimately admitted (odds ratio 0.93 per patient; 95% confidence interval 0.88 to 0.99) in the ED. The effect of additional patients was present below total ED capacity.Conclusion: As ED volume increases, ED patients with community-acquired pneumonia are less likely to receive timely antibiotic therapy. The effect of additional patients appears to occur even at volumes below the maximum bed capacity. Measures to ensure that quality targets are met in the ED should consider the impact of ED volume.