title: The association between emergency department crowding and hospital performance on antibiotic timing for pneumonia and percutaneous intervention for myocardial infarction.
abstract: BACKGROUND
  Antibiotics within four hours of arrival for patients with pneumonia and percutaneous intervention (PCI) within two hours for patients with acute myocardial infarction (AMI) are standard measures of emergency department (ED) quality.
  
  
  OBJECTIVE
  To assess the institutional-level association between measures of ED crowding and process measures for pneumonia and AMI.
  
  
  METHODS
  The authors used summary data from 24 academic hospitals in the University Health Consortium. Analysis included the 2004 ED cycle time survey and performance data from January to December 2004 regarding the Joint Commission for Accreditation of Healthcare Organizations' PN-5b (initial antibiotic administration within four hours) for pneumonia and AMI-8a (PCI received within 120 minutes). Spearman correlation coefficients were used to determine associations between crowding and performance measures.
  
  
  RESULTS
  Across all institutions, 59% (range 43%-77%) of pneumonia patients received antibiotics within four hours, and 57% (range 22%-95%) of AMI patients received PCI within two hours. An increase in overall ED length of stay (-0.44, p = 0.04) and for admitted patients (-0.37, p = 0.08) was associated with a decrease in the proportion of pneumonia patients receiving antibiotics within four hours. An increase in chest x-ray turnaround time (-0.83, p < 0.001) and an increase in the left-without-being-seen rate (-0.51, p = 0.01) were also associated with a decrease in the proportion of pneumonia patients receiving antibiotics within four hours. No measures of crowding exhibited an association with time to PCI for AMI patients.
  
  
  CONCLUSIONS
  Administrative measures of ED crowding showed an association with poorer performance on pneumonia quality of care measures but not with AMI quality of care measures. Hospitals might consider improving ED throughput, reducing boarding times for admitted patients, and reducing chest x-ray turnaround times to improve pneumonia care.
authors.affiliation: Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. pinesjes@uphs.upenn.edu
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
authors.forename: A Russell
authors.initials: AR
authors.lastname: Localio
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Metlay
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007902:Length of Stay; D009203:Myocardial Infarction / Q000628:therapy*; D011014:Pneumonia / Q000188:drug therapy*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D013997:Time Factors; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents