title: Systematic delays in antibiotic administration in the emergency department for adult patients admitted with pneumonia.
abstract: OBJECTIVE
  The authors sought to determine the contribution of delays in care on time to antibiotics for patients admitted from the emergency department (ED) with pneumonia and to identify patients at risk for delayed antibiotics.
  
  
  METHODS
  This was a retrospective cohort study of patients admitted to the Hospital of the University of Pennsylvania (HUP) and to Pennsylvania Presbyterian Hospital (Presbyterian) with an admission diagnosis of pneumonia in 2004.
  
  
  RESULTS
  A total of 393 patients were included. Ninety percent had antibiotics documented as given in the ED. Eighty-three (43%) of 209 at HUP and 104 (64%) of 161 patients at Presbyterian received antibiotics within four hours. Patients who received antibiotics more than four hours after ED arrival experienced longer waits for radiograph orders (HUP, 54 min [95% confidence interval {CI} = 33 to 76 min]; Presbyterian, 43 min [95% CI = 29 to 58 min]), for radiograph performance (HUP, 21 min [95% CI = 4 to 39 min], Presbyterian, 24 min [95% CI = 8 to 47 min]), for antibiotic orders (HUP, 56 min [95% CI = 38 to 95 min]; Presbyterian, 67 min [95% CI = 33 to 103 min]), and for antibiotic administration (HUP, 28 min [95% CI = 17 to 39 min]; Presbyterian, 30 min [95% CI = 21 to 38 min]). Patients with lower severity scores (p = 0.005) and patients with nonclassic clinical presentations for pneumonia were at increased risk for delayed antibiotics (odds ratio, 2.2; 95% CI = 1.1 to 4.4).
  
  
  CONCLUSIONS
  Antibiotic delays for patients admitted with pneumonia occur across multiple care processes. Less severely ill patients and patients with nonclassic presentations are at higher risk for delayed antibiotic administration. Hospitals should consider performing a similar analysis to evaluate hospital-specific and patient-specific care delays.
authors.affiliation: Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA. pinesjes@uphs.upenn.edu
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Morton
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Datner
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D017723:Drug Utilization Review; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015143:Philadelphia; D011014:Pneumonia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011785:Quality Assurance, Health Care; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents