Antibiotic Timing and Errors in Diagnosing Pneumonia

Welker, James A.; Huston, Michelle; McCue, Jack D.

doi:10.1001/archinternmed.2007.84

Cited by 156 publications

(92 citation statements)

References 19 publications

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“…Kanwar et al (56) and Welker et al (106) conclude that time to diagnosis did not improve, but the rate of false diagnoses increased and with it the inappropriate use of antibiotics, suggesting that not only was this regulation ineffective but it actually led to worse quality of care. Friedberg et al (36) studied a national sample of emergency departments and did not find evidence for dysfunctional responses.…”

Section: Studies Of Direct Regulation Outside Of the Nursing Home Sectormentioning

confidence: 99%

Top-Down and Bottom-Up Approaches to Health Care Quality: The Impacts of Regulation and Report Cards

Mukamel

Haeder²,

Weimer

2014

Annu. Rev. Public Health

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The high cost of the US health care system does not buy uniformly high quality of care. Concern about low quality has prompted two major types of public policy responses: regulation, a top-down approach, and report cards, a bottom-up approach. Each can result in either functional provider responses, which increase quality, or dysfunctional responses, which may lower quality. What do we know about the impacts of these two policy approaches to quality? To answer this question, we review the extant literature on regulation and report cards. We find evidence of both functional and dysfunctional effects. In addition, we identify the areas in which additional research would most likely be valuable.

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Section: Studies Of Direct Regulation Outside Of the Nursing Home Sectormentioning

confidence: 99%

Top-Down and Bottom-Up Approaches to Health Care Quality: The Impacts of Regulation and Report Cards

Mukamel

Haeder²,

Weimer

2014

Annu. Rev. Public Health

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“…Moreover, the appropriateness of some commonly used indicators has been questioned. 24 The absence of agreement on appropriate high-priority measures of quality of ED care prevents cross-jurisdiction comparisons, benchmarking, and the evaluation of quality improvement interventions.…”

Section: Ré Sumémentioning

confidence: 99%

Prioritizing performance measurement for emergency department care: consensus on evidencebased quality of care indicators

Schull

Guttmann

Leaver

et al. 2011

CJEM

102

101

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Background: The evaluation of emergency department (ED) quality of care is hampered by the absence of consensus on appropriate measures. We sought to develop a consensus on a prioritized and parsimonious set of evidence-based quality of care indicators for EDs. Methods: The process was led by a nationally representative steering committee and expert panel (representatives from hospital administration, emergency medicine, health information, government, and provincial quality councils). A comprehensive review of the scientific literature was conducted to identify candidate indicators. The expert panel reviewed candidate indicators in a modified Delphi panel process using electronic surveys; final decisions on inclusion of indicators were made by the steering committee in a guided nominal group process with facilitated discussion. Indicators in the final set were ranked based on their priority for measurement. A gap analysis identified areas where future indicator development is needed. A feasibility study of measuring the final set of indicators using current Canadian administrative databases was conducted.

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“…Also, most studies are heavily underpowered to find a small but relevant difference in mortality. Some authors have even raised concern about such a timescale because of the risk of overtreatment [43][44][45]. However, overtreatment is only a concern if antimicrobial treatment is inappropriately administered prior to a clear diagnosis.…”

Section: Pre-hospital and Early In-hospital Carementioning

confidence: 99%

Community-acquired pneumonia as an emergency: time for an aggressive intervention to lower mortality

Ewig¹,

Torres²

2011

Eur Respir J

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Community-acquired pneumonia (CAP) is one of the major contemporary acute lifethreatening conditions. Short-term mortality reaches 14% (7% if nursing-home residents and bedridden patients are excluded) and long-term mortality reaches 50% within 5 yrs.CAP and acute myocardial infarction (AMI) have a lot in common with regard to acuity, prognosis, need for risk stratification and early intervention, and secondary prevention measures. The obvious success in the treatment of AMI is due to an effective organisation of pre-hospital care and evidence-based interventions in the hospital within defined timescales.Less evidence is available about effective strategies to lower short-and long-term mortality in patients with CAP. Nevertheless, it is estimated that ,30% of hospitalised patients with CAP could be subject to a management approach in parallel to that of acute coronary syndrome (ACS).Management of patients with severe CAP should be intensified using all elements that have been established in the care for patients with ACS and stroke. One of the main challenges of future research will be to define whether and which additional patients at risk of mortality truly profit from timely and structured interventions. In the meantime, patients at increased risk of death according to clinical prediction tools should also be subject to an aggressive management approach.

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Antibiotic Timing and Errors in Diagnosing Pneumonia

Abstract: Reduction in the required TFAD from 8 to 4 hours seems to reduce the accuracy by which ED physicians diagnose pneumonia, while failing to reduce the actual TFAD achieved for patients.

Cited by 156 publications

References 19 publications

Top-Down and Bottom-Up Approaches to Health Care Quality: The Impacts of Regulation and Report Cards

Top-Down and Bottom-Up Approaches to Health Care Quality: The Impacts of Regulation and Report Cards

Prioritizing performance measurement for emergency department care: consensus on evidencebased quality of care indicators

Community-acquired pneumonia as an emergency: time for an aggressive intervention to lower mortality

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