title: Implementation of hospital-wide reform at improving access and flow: Impact on time to antibiotics in the emergency department.
abstract: BACKGROUND
  ED overcrowding has been associated with increased mortality, morbidity and delays to essential treatment. It was hypothesised that hospital-wide reforms designed to improve patient access and flow, in addition to improving ED overcrowding, would impact on clinically important processes within the ED, such as timely delivery of antibiotics.
  
  
  METHODS
  A single pre-implementation and post-implementation prospective cohort study was conducted prior to and after a hospital-wide reform (Timely Quality Care (TQC)). Among patients who had intravenous antibiotics prescribed in the ED, data were prospectively collected on times of presentation, prescription and administration of antibiotics. Demographics and discharge diagnoses were retrospectively extracted.
  
  
  RESULTS
  There were 380 cases included with 179 cases prior to introduction of the TQC model and 201 cases after its introduction. Time from presentation to administration of antibiotics improved significantly from 192 (99-320) min to 142 (81-209) min (P < 0.01). The time from presentation to prescription pre-TQC and post-TQC was 120 (51-230) min and 92 (49-153) min, respectively (P < 0.01). The times from prescription to administration pre-TQC and post-TQC were 43 (20-83) min and 34 (15-66) min, respectively (P = 0.03).
  
  
  CONCLUSIONS
  Following implementation of hospital-wide reform directed at mitigating ED overcrowding through improved access and flow, times to administration of antibiotics were significantly reduced. These findings suggest that improved quality of care in this area may be achieved with processes aimed at improved hospital access and flow. Ongoing evaluation and vigilance is necessary to ensure sustainability and drive further improvements.
authors.affiliation: Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia.
authors.forename: Cristina P
authors.initials: CP
authors.lastname: Roman
authors.affiliation: Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia.|Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
authors.forename: Susan G
authors.initials: SG
authors.lastname: Poole
authors.affiliation: Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia.|Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Dooley
authors.affiliation: Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: De Villiers
authors.initials: de V
authors.lastname: Smit
authors.affiliation: Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.|Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Biswadev
authors.initials: B
authors.lastname: Mitra
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003441:Crowding; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D018166:Health Care Reform; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care / Q000458:organization & administration; D013997:Time Factors; D014739:Victoria; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: anti-bacterial agents; emergency service; healthcare reform; hospital; pharmacy; sepsis