title: Weekly E-mail reminders influence emergency physician behavior: a case study using the Joint Commission and Centers for Medicare and Medicaid Services Pneumonia Guidelines.
abstract: OBJECTIVE
  Improving physician compliance with evidence-based guidelines is challenging. The authors wanted to determine if weekly e-mail reminders to emergency department (ED) staff increase compliance with Joint Commission and the Centers for Medicare and Medicaid Services (CMS) community-acquired pneumonia quality measures.
  
  
  METHODS
  One nurse administrator reviewed records on a weekly basis for all adult patients admitted to the hospital from the ED with a working diagnosis of pneumonia. An e-mail was then sent to all ED staff indicating the percentage of patients with antibiotic timing less than 4 hours from arrival. The names of individuals who administered antibiotics in less than 1 hour were highlighted. This study compared the time to antibiotics for 11 months before and 11 months after commencing this intervention.
  
  
  RESULTS
  There were 281 patients in the control cohort, and 37 met exclusion criteria, leaving 244 for analysis. There were 342 patients in the intervention cohort, and 40 met exclusion criteria, leaving 302 for analysis. The median time from arrival to chest radiograph order decreased significantly from 61 to 47 minutes (p < 0.001). The median time interval from chest radiograph order to antibiotic administration did not change significantly (92 to 88 minutes, p = 0.294). The overall median time from arrival to antibiotic administration decreased significantly from 162 to 146 minutes (p = 0.018). The percentage of patients with antibiotic administration within 4 hours increased from 77.5% to 86.1% (p = 0.009).
  
  
  CONCLUSIONS
  Weekly e-mail reminders listing performance on antibiotic administration recommendations are associated with increased compliance with a clinical guideline.
authors.affiliation: Department of Emergency Medicine, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA. sweiner@tuftsmedicalcenter.org
authors.forename: Scott G
authors.initials: SG
authors.lastname: Weiner
authors.forename: Sanford F
authors.initials: SF
authors.lastname: Brown
authors.forename: Jessica D
authors.initials: JD
authors.lastname: Goetz
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Webber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D014487:Centers for Medicare and Medicaid Services, U.S.; D034742:Electronic Mail; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D019982:Organizational Case Studies; D011014:Pneumonia / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013902:Radiography, Thoracic; D017010:Reminder Systems; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents