A quality improvement initiative to improve adherence to national guidelines for empiric management of community-acquired pneumonia in emergency departments
McIntosh, KA and Maxwell, DJ and Pulver, LK and Horn, F and Robertson, MB and Kaye, KI and Peterson, GM and Dollman, WB and Wai, A and Tett, SE, A quality improvement initiative to improve adherence to national guidelines for empiric management of community-acquired pneumonia in emergency departments, International Journal for Quality in Health Care, 23, (2) pp. 142-150. ISSN 1353-4505 (2011) [Refereed Article]
Objective. The objective of this study was to improve the concordance of community-acquired pneumonia management in
Australian emergency departments with national guidelines through a quality improvement initiative promoting concordant
antibiotic use and use of a pneumonia severity assessment tool, the pneumonia severity index (PSI).
Design and Interventions. Drug use evaluation, a quality improvement methodology involving data collection, evaluation,
feedback and education, was undertaken. Educational interventions included academic detailing, group feedback presentations
and prescribing prompts.
Setting and Participants. Data were collected on 20 consecutive adult community-acquired pneumonia emergency department
presentations by each hospital for each of three audits.
Main Outcome Measures. Two process indicators measured the impact of the interventions: documented PSI use and concordance
of antibiotic prescribing with guidelines. Comparisons were performed using a Chi-squared test.
Results. Thirty-seven hospitals, including public, private, rural and metropolitan institutions, participated. Twenty-six hospitals
completed the full study (range: 462518 patients), incorporating two intervention phases and subsequent follow-up audits.
The baseline audit of community-acquired pneumonia management demonstrated that practice was varied and mostly discordant
with guidelines. Documented PSI use subsequently improved from 30/518 (6%, 95% confidence interval [CI] 48) at
baseline to 125/503 (25%, 95% CI 2129; P, 0.0001) and 102/462 (22%, 95% CI 1826; P, 0.0001) in audits two and
three, respectively, while concordant antibiotic prescribing improved from 101/518 (20%, 95% CI 1623) to 132/462 (30%,
95% CI 2634; P, 0.0001) and 132/462 (29%, 95% CI 2433; P, 0.001), respectively.
Conclusions. Improved uptake of guideline recommendations for community-acquired pneumonia management in emergency
departments was documented following a multi-faceted education intervention.
guideline adherence, community-acquired infections, pneumonia/[drug therapy], quality assurance, health care,