Quality of care in patients with community acquired pneumonia and sepsis in a Swiss hospital.
OBJECTIVE
Community acquired pneumonia (CAP) and sepsis are leading causes of hospitalisation after admission to a medical emergency department (ED). Identifying these potentially life-threatening diseases is not always easy due to often unspecific or minimal symptoms. However, quick application of antibiotics is known to be crucial and is correlated with better outcome. The international guidelines of the joint commission suggest a 4 hour-rule for optimal quality of care in CAP and sepsis. In this study we assessed the door-to-needle time (DNT) in patients admitted to our ED with the diagnosis of CAP and/or sepsis. Furthermore we investigated the CRB-65 score, its clinical performance and its influence on DNT.


METHODS
Retrospective observational study of all patients admitted and hospitalised through the ED of a Swiss hospital with the diagnosis of sepsis or pneumonia from June 2009 to June 2010 (n = 139).


RESULTS
In 73% of the cases DNT was lower than the recommended 4 hours. In CAP, a correlation between the CRB-65 and DNT was not found (ρ = 0.13, p = 0.30). Further parameters, e.g. temperature or blood pressure did not improve DNT significantly. Analysis of the CRB-65 score was regularly impeded due to absent documented information on respiratory rate or confusion state.


CONCLUSIONS
In most cases it was feasible to fulfill the 4 hours DNT. The CRB-65 score is an easy bedside tool, which was not routinely assessed by our emergency room personnel but its assessment did not affect DNT in our hospital.
Clinic of Internal Medicine, Uster Hospital, Switzerland.
Corinne C
CC
Widmer
Esther B
EB
Bachli
D000368:Aged; D017714:Community-Acquired Infections / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching; D006801:Humans; D007297:Inpatients; D008297:Male; D018410:Pneumonia, Bacterial / Q000628:therapy*; D011787:Quality of Health Care; D012189:Retrospective Studies; D018805:Sepsis / Q000628:therapy*; D013557:Switzerland; D013997:Time Factors