An intervention to improve antibiotic delivery and sputum procurement in patients hospitalized with community-acquired pneumonia.
OBJECTIVE
To determine if an educational intervention targeting emergency department (ED) and medicine staff could successfully decrease the time to antibiotic delivery (door-to-drug delivery time [DDD]) for patients admitted through the ED with community-acquired pneumonia (CAP).


METHODS
Prospective, multidisciplinary team-based educational project. Demographics, outcomes, and processes of care including DDD and sputum procurement for patients with CAP were determined during a baseline period and compared to the same parameters for patients with CAP presenting after the educational intervention was administered to ED and medicine staff.


METHODS
Barnes-Jewish Hospital, a large Midwest teaching institution affiliated with the Washington University School of Medicine.


METHODS
Consecutive adult patients admitted through the ED with CAP.


METHODS
Multidisciplinary in-service education administered to ED physicians and nurses, and medicine housestaff, which emphasized the importance of rapid antibiotic delivery and procurement of preantibiotic expectorated sputum.


RESULTS
Mean DDD improved from 413 to 291 min (p = 0.02), with more patients receiving antibiotics in the ED (46% vs 69%; adjusted odds ratio [OR], 2.3; 95% confidence interval [CI], 1.0 to 4.9). Sputum procurement improved from 11.5 to 25.4% (adjusted OR, 3.3; 95% CI, 1.1 to 9.9). There were no observed differences for inpatient mortality or length of stay.


CONCLUSIONS
This multidisciplinary team intervention significantly improved the time to initiation of antibiotics and procurement of sputum for patients with CAP.
Lawrence
Steven J
SJ
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110, USA. slawrenc@im.wustl.edu
Shadel
Brooke N
BN
Leet
Terry L
TL
Hall
Jonathan B
JB
Mundy
Linda M
LM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007318:Inservice Training; D008297:Male; D008875:Middle Aged; D008923:Missouri; D010348:Patient Care Team; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D013996:Time and Motion Studies
D000900:Anti-Bacterial Agents