Effect of an automated chest radiograph at triage protocol on time to antibiotics in patients admitted with pneumonia.
OBJECTIVE
We derived and tested a protocol to automatically order a chest radiograph (CXR) at emergency department triage for patients with signs and symptoms of pneumonia to reduce time to antibiotics.


METHODS
We derived a protocol using a retrospective study of admitted adult patients with pneumonia then prospectively tested the protocol on time to antibiotics. The protocol included patients with a chief complaint of chest pain, shortness of breath, upper respiratory tract infection, hemoptysis, fever, and cough. Of those, patients 50 years or older with any vital sign abnormality and patients younger than 50 with a comorbidity of immunocompromise, cancer, diabetes, transplant, or chronic alcoholism had a CXR ordered automatically.


RESULTS
Although the protocol was only 35% (95% confidence interval, 28%-43%) sensitive in identifying patients admitted with pneumonia, time to antibiotics (in hours) (3.4 vs 4.2, P = .01) and time to CXR (3.0 vs 2.0, P = .01) for patients admitted with pneumonia were lower during the study period.


CONCLUSIONS
Automated CXR at triage reduces time to antibiotics in patients admitted with pneumonia.
Cooper
Julie J
JJ
University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Datner
Elizabeth M
EM
Pines
Jesse M
JM
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001331:Automation; D016009:Chi-Square Distribution; D002985:Clinical Protocols; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013997:Time Factors; D014218:Triage
D000900:Anti-Bacterial Agents