Quality of care in elder emergency department patients with pneumonia: a prospective cohort studyReport as inadecuate




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BMC Emergency Medicine

, 8:6

First Online: 30 April 2008Received: 06 June 2007Accepted: 30 April 2008DOI: 10.1186-1471-227X-8-6

Cite this article as: Caterino, J.M., Hiestand, B.C. & Martin, D.R. BMC Emerg Med 2008 8: 6. doi:10.1186-1471-227X-8-6

Abstract

BackgroundThe goals of the study were to assess the relationship between age and processes of care in emergency department ED patients admitted with pneumonia and to identify independent predictors of failure to meet recommended quality care measures.

MethodsThis was a prospective cohort study of a pre-existing database undertaken at a university hospital ED in the Midwest. ED patients ≥18 years of age requiring admission for pneumonia, with no documented use of antibiotics in the 24 hours prior to ED presentation were included. Compliance with Pneumonia National Quality Measures was assessed including ED antibiotic administration, antibiotics within 4 hours, oxygenation assessment, and obtaining of blood cultures. Odds ratios were calculated for elders and non-elders. Logistic regression was used to identify independent predictors of process failure.

ResultsOne thousand, three hundred seventy patients met inclusion criteria, of which 560 were aged ≥65 years. In multiple variable logistic regression analysis, age ≥65 years was independently associated with receiving antibiotics in the ED odds ratio OR = 2.03, 95% CI 1.28–3.21 and assessment of oxygenation OR = 2.10, 95% CI, 1.18–3.32. Age had no significant impact on odds of receiving antibiotics within four hours of presentation OR 1.10, 95% CI 0.84–1.43 or having blood cultures drawn OR 1.02, 95%CI 0.78–1.32. Certain other patient characteristics were also independently associated with process failure.

ConclusionElderly patients admitted from the ED with pneumonia are more likely to receive antibiotics while in the ED and to have oxygenation assessed in the ED than younger patients. The independent association of certain patient characteristics with process failure provides an opportunity to further increase compliance with recommended quality measures in admitted patients diagnosed with pneumonia.

Jeffrey M Caterino, Brian C Hiestand and Daniel R Martin contributed equally to this work.

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Author: Jeffrey M Caterino - Brian C Hiestand - Daniel R Martin

Source: https://link.springer.com/







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