American Journal of Emergency Medicine
Volume 28, Issue 1 , Pages 23-31, January 2010

ED antibiotic use for acute respiratory illnesses since pneumonia performance measure inception☆☆☆

  • Christopher Fee, MD

      Affiliations

    • Department of Emergency Medicine, University of California San Francisco, San Francisco, CA 94143, USA
    • Corresponding Author InformationCorresponding author. Department of Emergency Medicine, UCSF Medical Center, Box 0208, San Francisco, CA 94143, USA. Tel.: +1 415 353 1634; fax: +1 415 3531799.
    • ,
  • Joshua P. Metlay, MD, PhD

      Affiliations

    • Division of General Internal Medicine, University of Pennsylvania School of Medicine and VA Medical Center, Philadelphia, PA 19104, USA
    • ,
  • Carlos A. Camargo Jr, MD, DrPH

      Affiliations

    • Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
    • ,
  • Judith H. Maselli, MSPH

      Affiliations

    • Department of Medicine, University of California San Francisco, San Francisco, CA 94118, USA
    • ,
  • Ralph Gonzales, MD, MSPH

      Affiliations

    • Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA 94118, USA

Received 1 July 2008; received in revised form 9 September 2008; accepted 10 September 2008. published online 22 October 2009.

Abstract 

Objective

The study aimed to determine if emergency department (ED)–administered antibiotics for patients discharged home with nonpneumonia acute respiratory tract infections (ARIs) have increased since national pneumonia performance measure implementation, including antibiotic administration within 4 hours of arrival.

Methods

Design: Time series analysis. Setting: Six university and 7 Veterans Administration EDs participating in the Improving Antibiotic Use for Acute Care Treatment (IMPAACT) trial (randomized educational intervention to reduce antibiotics for bronchitis). Participants: Randomly selected adult (age >18 years) ED visits for acute cough, diagnosed with nonpneumonia ARIs, discharged home during winters (November-February) of 2003 to 2007. Main outcome: Time trend in ED-administered antibiotics, adjusted for patient demographics, comorbidities, vital signs, ED length of stay, IMPAACT intervention status, geographic region, Veterans Administration/university setting, and site and provider level clustering.

Results

Six thousand four hundred seventy-six met study criteria. Three hundred ninety-four (6.1%) received ED-administered antibiotics. Emergency department–administered antibiotics did not increase across the study period among all IMPAACT sites (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.76-1.01) after adjusting for age, congestive heart failure history, temperature higher than 100°F, heart rate more than 100, blood cultures obtained, diagnoses, and ED length of stay. The ED-administered antibiotic rate decreased at IMPAACT intervention (OR, 0.80; 95% CI, 0.69-0.93) but not nonintervention sites (OR, 1.04; 95% CI, 0.91-1.19). Adjusted proportions receiving ED-administered antibiotics were 6.1% (95% CI, 2.7%-13.2%) for 2003 to 2004; 4.8% (95% CI, 2.2%-10.0%) for 2004 to 2005; 4.6% (95% CI, 2.7%-7.8%) for 2005 to 2006; and 4.2% (95% CI, 2.2%-8.0%) for 2006 to 2007.

Conclusions

Emergency department–administered antibiotics did not increase for patients with acute cough discharged home with nonpneumonia ARIs since pneumonia antibiotic timing performance measure implementation in these academic EDs.

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☆ This study was funded by the Translating Research into Practice initiative, jointly sponsored by the Agency for Healthcare Research and Quality, Rockville, Maryland (1 R01 HS013915) and the Health Services Research and Development Office of the Department of Veterans Affairs, Washington, D.C. (AVA-03-239). The funding agencies had no role in the design and conduct of the study; collection management, analysis, and interpretation of the data; or preparation, review, or approval of the article.

☆☆ Dr Metlay has served as a scientific consultant or received unrestricted educational funds from Aventis Pharmaceuticals and Roche Pharmaceuticals. Dr Gonzales served as a consultant for Abbott Laboratories, Inc, to study C-reactive protein levels as a potential diagnostic test for outpatients with community-acquired pneumonia. Dr Camargo has received financial support for participation in conferences, consulting, and medical research from the following industry sponsors with an interest in respiratory infections: Abbott, Aventis, Aventis Pasteur, GlaxoSmithKline, MedImmune, and Merck.

PII: S0735-6757(08)00662-1

doi:10.1016/j.ajem.2008.09.023

American Journal of Emergency Medicine
Volume 28, Issue 1 , Pages 23-31, January 2010

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