Quality of care in elder emergency department patients with pneumonia: a prospective cohort study.
BACKGROUND
The goals of the study were to assess the relationship between age and processes of care in emergency department (ED) patients admitted with pneumonia and to identify independent predictors of failure to meet recommended quality care measures.


METHODS
This was a prospective cohort study of a pre-existing database undertaken at a university hospital ED in the Midwest. ED patients > or =18 years of age requiring admission for pneumonia, with no documented use of antibiotics in the 24 hours prior to ED presentation were included. Compliance with Pneumonia National Quality Measures was assessed including ED antibiotic administration, antibiotics within 4 hours, oxygenation assessment, and obtaining of blood cultures. Odds ratios were calculated for elders and non-elders. Logistic regression was used to identify independent predictors of process failure.


RESULTS
One thousand, three hundred seventy patients met inclusion criteria, of which 560 were aged > or =65 years. In multiple variable logistic regression analysis, age > or =65 years was independently associated with receiving antibiotics in the ED (odds ratio [OR] = 2.03, 95% CI 1.28-3.21) and assessment of oxygenation (OR = 2.10, 95% CI, 1.18-3.32). Age had no significant impact on odds of receiving antibiotics within four hours of presentation (OR 1.10, 95% CI 0.84-1.43) or having blood cultures drawn (OR 1.02, 95%CI 0.78-1.32). Certain other patient characteristics were also independently associated with process failure.


CONCLUSIONS
Elderly patients admitted from the ED with pneumonia are more likely to receive antibiotics while in the ED and to have oxygenation assessed in the ED than younger patients. The independent association of certain patient characteristics with process failure provides an opportunity to further increase compliance with recommended quality measures in admitted patients diagnosed with pneumonia.
Caterino
Jeffrey M
JM
Department of Emergency Medicine, The Ohio State University, Means Hall, 1654 Upham Drive, Columbus, OH 43210, USA . jeffrey.caterino@osumc.edu
Hiestand
Brian C
BC
Martin
Daniel R
DR
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001784:Blood Gas Analysis; D015331:Cohort Studies; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D011014:Pneumonia / Q000175:diagnosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D013997:Time Factors
D000900:Anti-Bacterial Agents; D010100:Oxygen