Time to Antibiotic Delivery in Pneumonia - Is it Really an Important Marker of Quality of Care?

Mark      L. Metersky

Abstract

A delay in time between arrival to the hospital or emergency department and the time to first antibiotic dose (TFAD) in patients with community-acquired pneumonia has been found to correlate with an increased risk of mortality. This finding, in combination with increasing realization during the 1990s that there was an unnecessary delay in antibiotic treatment for many patients led regulatory bodies and payers in the United States to use TFAD as a measure for public reporting and/or pay for performance programs. The use of this measure has generated a great deal of controversy due to the lack of prospective, randomized data demonstrating improved outcomes in patients who receive earlier antibiotics. There is also evidence suggesting that efforts to deliver antibiotics earlier have resulted in increased numbers of patients getting unnecessary antibiotics, as many patients present in an atypical manner making it difficult to rapidly confirm a diagnosis of pneumonia. Nonetheless, intuitive, biologic and observational data support the importance of rapid delivery of antibiotics to patients with pneumonia. In the United States, 93% of patients presenting to the hospital with pneumonia now receive antibiotics within 6 hours. This suggests that there is limited opportunity for further improvement and that this measure may have outlived its usefulness.

Keywords: Pneumonia, treatment outcome, quality of health care, quality indicators, health care, outcome and process assessment (health care), guideline adherence, community-acquired pneumonia, regulatory bodies, antibiotics, time to first antibiotic dose, Feasibility