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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

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