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Clinical Investigations: PNEUMONIA |

An Intervention To Improve Antibiotic Delivery and Sputum Procurement in Patients Hospitalized With Community-Acquired Pneumonia*

Steven J. Lawrence, MD; Brooke N. Shadel, PhD, MPH; Terry L. Leet, PhD; Jonathan B. Hall, MD; Linda M. Mundy, MD
Author and Funding Information

*From the Division of Infectious Diseases (Drs. Lawrence and Mundy) and Division of Emergency Medicine (Dr. Hall), Washington University School of Medicine; and Saint Louis University School of Public Health (Dr. Leet) and Center for the Study of Bioterrorism and Emerging Infections (Dr. Shadel), St. Louis, MO.

Correspondence to: Steven J. Lawrence, MD, Washington University School of Medicine, Division of Infectious Diseases, 660 South Euclid Ave, Campus Box 8051, St. Louis, MO 63110; e-mail: slawrenc@im.wustl.edu



Chest. 2002;122(3):913-919. doi:10.1378/chest.122.3.913
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Study objectives: To determine if an educational intervention targeting emergency department (ED) and medicine staff could successfully decrease the time to antibiotic delivery (door-to-drug delivery time [DDD]) for patients admitted through the ED with community-acquired pneumonia (CAP).

Design: Prospective, multidisciplinary team-based educational project. Demographics, outcomes, and processes of care including DDD and sputum procurement for patients with CAP were determined during a baseline period and compared to the same parameters for patients with CAP presenting after the educational intervention was administered to ED and medicine staff.

Setting: Barnes-Jewish Hospital, a large Midwest teaching institution affiliated with the Washington University School of Medicine.

Patients: Consecutive adult patients admitted through the ED with CAP.

Intervention: Multidisciplinary in-service education administered to ED physicians and nurses, and medicine housestaff, which emphasized the importance of rapid antibiotic delivery and procurement of preantibiotic expectorated sputum.

Results: Mean DDD improved from 413 to 291 min (p = 0.02), with more patients receiving antibiotics in the ED (46% vs 69%; adjusted odds ratio [OR], 2.3; 95% confidence interval [CI], 1.0 to 4.9). Sputum procurement improved from 11.5 to 25.4% (adjusted OR, 3.3; 95% CI, 1.1 to 9.9). There were no observed differences for inpatient mortality or length of stay.

Conclusion: This multidisciplinary team intervention significantly improved the time to initiation of antibiotics and procurement of sputum for patients with CAP.


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