Pneumonia quality measures not associated with antibiotics for congestive heart failure patients.
BACKGROUND
Pneumonia antibiotic timing performance measures can result in unnecessary antibiotic administration to patients in whom a diagnosis of pneumonia remains possible but has not been confirmed.


OBJECTIVE
Our objective was to determine if unnecessary antibiotic administration to admissions with Emergency Department (ED) congestive heart failure (CHF) diagnoses increased as institutional attention to pneumonia antibiotic timing intensified.


METHODS
We performed a cross-sectional study in an academic ED with 39,000 annual visits. Our subjects included adult admissions with ED CHF diagnoses between October and March of 2004-2005, 2005-2006, and 2006-2007. We excluded patients with any concomitant infectious diagnosis from primary analysis. We obtained patient age, sex, triage acuity, vital signs, ED diagnoses, and admitting service from electronic databases. Trained abstractors confirmed infectious diagnosis presence and noted if antibiotics were administered. Inter-observer agreement was assessed. Multivariate logistic regression determined association of time period with antibiotic administration. We assessed trends in concomitant infectious diagnoses.


RESULTS
Of 778 CHF admissions, 125 had infectious diagnoses, leaving 653 for primary analysis. Inter-observer agreement was good to excellent (κ = 0.71-0.83). Demographic and presenting characteristics did not vary by period. Antibiotics were administered to 18.4% (95% confidence interval [CI] 12.7-23.3), 15.0% (95% CI 9.6-18.5), and 15.1% (95% CI 10.2-19.8), per period, respectively. Time period was not associated with antibiotics, odds ratios were 0.8 (95% CI 0.5-1.4) and 0.9 (95% CI 0.5-1.6) for periods 2 and 3, respectively. Concomitant infectious diagnoses did not increase significantly (from 15.5% to 19.4%). Pneumonia antibiotic timing compliance remained low (50-70%).


CONCLUSIONS
Unnecessary antibiotic administration to ED CHF admissions did not increase as institutional scrutiny of pneumonia antibiotic timing intensified, although neither did compliance with pneumonia antibiotic timing.
Department of Emergency Medicine, University of California, San Francisco, California, USA.
Christopher
C
Fee
Nicholas
N
Johnson
Hugo
H
Torres
Ellen J
EJ
Weber
D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000592:standards; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011014:Pneumonia / Q000150:complications* / Q000517:prevention & control*