A quality improvement initiative to improve adherence to national guidelines for empiric management of community-acquired pneumonia in emergency departments.
OBJECTIVE
The objective of this study was to improve the concordance of community-acquired pneumonia management in Australian emergency departments with national guidelines through a quality improvement initiative promoting concordant antibiotic use and use of a pneumonia severity assessment tool, the pneumonia severity index (PSI).


METHODS
and


METHODS
Drug use evaluation, a quality improvement methodology involving data collection, evaluation, feedback and education, was undertaken. Educational interventions included academic detailing, group feedback presentations and prescribing prompts.


METHODS
Data were collected on 20 consecutive adult community-acquired pneumonia emergency department presentations by each hospital for each of three audits.


METHODS
Two process indicators measured the impact of the interventions: documented PSI use and concordance of antibiotic prescribing with guidelines. Comparisons were performed using a Chi-squared test.


RESULTS
Thirty-seven hospitals, including public, private, rural and metropolitan institutions, participated. Twenty-six hospitals completed the full study (range: 462-518 patients), incorporating two intervention phases and subsequent follow-up audits. The baseline audit of community-acquired pneumonia management demonstrated that practice was varied and mostly discordant with guidelines. Documented PSI use subsequently improved from 30/518 (6%, 95% confidence interval [CI] 4-8) at baseline to 125/503 (25%, 95% CI 21-29; P < 0.0001) and 102/462 (22%, 95% CI 18-26; P < 0.0001) in audits two and three, respectively, while concordant antibiotic prescribing improved from 101/518 (20%, 95% CI 16-23) to 132/462 (30%, 95% CI 26-34; P < 0.0001) and 132/462 (29%, 95% CI 24-33; P < 0.001), respectively.


CONCLUSIONS
Improved uptake of guideline recommendations for community-acquired pneumonia management in emergency departments was documented following a multi-faceted education intervention.
Department of Human Services, Statewide Quality Branch, Melbourne, VIC, Australia.
Kylie A
KA
McIntosh
David J
DJ
Maxwell
Lisa K
LK
Pulver
Fiona
F
Horn
Marion B
MB
Robertson
Karen I
KI
Kaye
Gregory M
GM
Peterson
William B
WB
Dollman
Angela
A
Wai
Susan E
SE
Tett
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001315:Australia; D017714:Community-Acquired Infections / Q000188:drug therapy*; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D012720:Severity of Illness Index
D000900:Anti-Bacterial Agents