title: Reporting hospitals' antibiotic timing in pneumonia: adverse consequences for patients?
abstract: OBJECTIVE
  To determine whether publicly reporting hospital scores on antibiotic timing in pneumonia (percentage of patients with pneumonia receiving antibiotics within 4 hours) has led to unintended adverse consequences for patients.
  
  
  METHODS
  Retrospective analyses of 13,042 emergency department (ED) visits by adult patients with respiratory symptoms in the National Hospital Ambulatory Medical Care Survey, 2001-2005.
  
  
  METHODS
  Rates of pneumonia diagnosis, antibiotic use, and waiting times to see a physician were compared before and after public reporting, using a nationally representative hospital sample. These outcomes also were compared between hospitals with different antibiotic timing scores.
  
  
  RESULTS
  There were no differences in rates of pneumonia diagnosis (10% vs 11% of all ED visits, P = .72) or antibiotic administration (34% vs 35%, P = .21) before and after antibiotic timing score reporting. Mean waiting times to be seen by a physician increased similarly for patients with and without respiratory symptoms (11-minute vs 6-minute increase, respectively; P = .29). After adjustment for confounders, hospitals with higher 2005 antibiotic timing scores had shorter mean waiting times for all patients, but there were no significant score-related trends for rates of pneumonia diagnosis or antibiotic use.
  
  
  CONCLUSIONS
  Despite concerns, public reporting of hospital antibiotic timing scores has not led to increased pneumonia diagnosis, antibiotic use, or a change in patient prioritization.
authors.affiliation: Division of General Medicine, Brigham and Women's Hospital, 1620 Tremont St, BC-3-2X, Boston, MA 02120, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Friedberg
authors.forename: Ateev
authors.initials: A
authors.lastname: Mehrotra
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Linder
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D004363:Drug Utilization; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D011014:Pneumonia / Q000188:drug therapy*; D012189:Retrospective Studies; D013997:Time Factors; D014850:Waiting Lists
chemical_list: D000900:Anti-Bacterial Agents