title: Impact of physician-assisted triage on timing of antibiotic delivery in patients admitted to the hospital with community-acquired pneumonia (CAP).
abstract: BACKGROUND
  Time to antibiotic delivery in patients with diagnosis of pneumonia is a publicly reported quality measure.
  
  
  OBJECTIVE
  We aim to describe the impact of emergency department (ED) physician-assisted triage (PAT) on The Joint Commission (TJC) and Centers for Medicare and Medicaid Services (CMS) pneumonia core quality measures of timing to antibiotic delivery.
  
  
  METHODS
  Retrospective case series studies of patients admitted to the hospital through the ED with diagnosis of community-acquired pneumonia were identified over a period of 48 months. Patients were included in the study if they met TJC/CMS PN-5 (antibiotic timing) criteria. We compared antibiotic delivery timing before and after implementation of PAT in moderate-acuity patients using Wilcoxon rank sum tests. A linear regression analysis was done to account for age, sex, ED volume, and acuity level.
  
  
  RESULTS
  A total of 659 patients were identified: 497 patients and 162 patients enrolled pre- and post-implementation of a PAT, respectively. The median antibiotic delivery times for moderate-acuity patients during open hours of operation of PAT were 180min (pre) and 195min (post), p=0.027; this was unchanged when ED volume, age, sex, and acuity level were accounted for. A total of 43 patients (9%) and 13 patients (8%) failed to receive antibiotics within 6h of ED presentation before and after implementation of PAT, respectively.
  
  
  CONCLUSIONS
  In this study, implementation of PAT did not result in overall decrease in antibiotic delivery time in patients admitted to the hospital with CAP. We postulate several explanations for this delay in antibiotic delivery time.
authors.affiliation: Harvard Affiliated Emergency Medicine Residency, Brigham & Women's Hospital and Massachusetts General Hospital, Boston, MA 02115, USA.
authors.forename: Roberta
authors.initials: R
authors.lastname: Capp
authors.forename: Olan A
authors.initials: OA
authors.lastname: Soremekun
authors.forename: Paul D
authors.initials: PD
authors.lastname: Biddinger
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: White
authors.forename: Linda M
authors.initials: LM
authors.lastname: Sweeney
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: David F M
authors.initials: DF
authors.lastname: Brown
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017714:Community-Acquired Infections / Q000188:drug therapy; D003441:Crowding; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008404:Massachusetts; D062072:Patient Acuity; D010343:Patient Admission; D010819:Physician's Role; D011014:Pneumonia / Q000188:drug therapy*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000592:standards* / Q000706:statistics & numerical data; D014218:Triage
chemical_list: D000900:Anti-Bacterial Agents