A comprehensive approach to achieving near 100% compliance with The Joint Commission Core Measures for pneumonia antibiotic timing

Hill, Peter M.; Rothman, Richard; Saheed, Mustapha; DeRuggiero, Kathy; Hsieh, Yu-Hsiang; Kelen, Gabor D.

doi:10.1016/j.ajem.2010.05.011

« Previous Next »American Journal of Emergency Medicine
Volume 29, Issue 9 , Pages 989-998, November 2011

A comprehensive approach to achieving near 100% compliance with The Joint Commission Core Measures for pneumonia antibiotic timing☆☆☆

Peter M. Hill, MD
- The Johns Hopkins Hospital, Baltimore, Maryland, 21287, USA
- Corresponding author. The Department of Emergency Medicine, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA. Tel.: +1 410 955 8708(Office); fax: +1 410 614 0141.
Richard Rothman, MD, PhD
- The Johns Hopkins Hospital, Baltimore, Maryland, 21287, USA
Mustapha Saheed, MD
- The Johns Hopkins Hospital, Baltimore, Maryland, 21287, USA
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA
Kathy DeRuggiero, RN
- The Johns Hopkins Hospital, Baltimore, Maryland, 21287, USA
Yu-Hsiang Hsieh, PhD
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA
Gabor D. Kelen, MD
- The Johns Hopkins Hospital, Baltimore, Maryland, 21287, USA
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA

Received 23 February 2010; received in revised form 16 April 2010; accepted 18 May 2010. published online 16 July 2010.

Abstract

Background

Adherence to The Joint Commission (TJC) Core Measures benchmarks is required for hospital accreditation, and data are publicly reported as an indication of hospital quality. Published approaches to date for adhering to the pneumonia antibiotic timing (PN5c) Core Measure have shown moderate to limited success in reaching high levels of compliance.

Objective

The objective of the study was to evaluate the effectiveness of a 3-phased intervention directed at improving compliance with TJC pneumonia antibiotic administration within the 6-hour requirement (PN5c) in an academic urban emergency department.

Methods

A 3-phase interventional study with retrospective analysis of contemporaneous data collection during a 57-month period ending September 2009 was performed. Phase 0 was baseline, phase 1 was physician evaluation at triage, phase 2 was implementation of a specific pneumonia screening tool and pathway, and phase 3 was implementation of an emergency department electronic medical record system that facilitates removing subjects with “diagnostic uncertainty” from consideration. Main outcome measure was the proportion of patients receiving antibiotics within 6 hours among those meeting PN5c criteria. Mean times to antibiotics and percentage of compliance with PN5c were compared for each phase.

Results

Percentage of compliance with PN5c increased from a baseline of 77% through each of the 3 phases: 85%, 91%, and 95%, respectively (Cochran-Armitage trend, P < .001). Mean time to antibiotic administration decreased from a baseline of 285 minutes with each successive intervention to 224, 189, and 169 minutes, respectively (linear regression, P < .001).

Conclusion

Implementation of a structured intervention that includes early physician triage, a screening tool for immediate imaging and reporting, and electronic record–facilitated compliance review effectively improves TJC PN5c compliance to high levels.