Abstract
Objective
We measured the correlation between emergency department (ED) occupancy rate and time
to antibiotic administration for patients with pneumonia treated in a community hospital
setting.
Methods
We reviewed quality improvement data on patients treated for pneumonia in our ED and
admitted over a 5-month period. The outcomes were timeliness of antibiotic therapy
(within 4 hours of arrival) and overall time to antibiotic administration. Emergency
department crowding was measured as the ED occupancy rate. We calculated (1) the Spearman
correlation between occupancy rate at time of patient presentation and the time to
antibiotic administration, (2) the odds ratio of receiving antibiotics within 4 hours
with increasing ED occupancy, and (3) the ability of the occupancy rate to predict
failure of achieving the 4-hour goal with the receiver operating characteristic curve.
Results
A total of 334 patients were treated over the study period, of which 262 had complete
data available. Occupancy rate ranged from 20% to 245%, and median was 137%. Eighty-one
percent received antibiotics within 4 hours; the median time was 150 minutes. Time
to antibiotics showed a positive correlation with occupancy rate (Spearman ρ = 0.17, P = .008). An increasing ED occupancy rate was associated with decreased odds of receiving
antibiotics within 4 hours (odds ratio, 0.31; 95% confidence interval, 0.13-0.75).
Receiver operating characteristic curve area was 0.62 (95% confidence interval, 0.54-0.70;
P = .009).
Conclusion
Emergency department occupancy rate was associated with increased time to antibiotic
treatment for patients admitted with pneumonia. Occupancy rate had fair success in
predicting failure of treatment within 4 hours.
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Article Info
Publication History
Published online: September 18, 2009
Accepted:
June 10,
2009
Received in revised form:
June 9,
2009
Received:
May 1,
2009
Footnotes
Presented at the American College of Emergency Physicians Research Forum held in Chicago, IL, October 2008.
☆No outside funding or support was received.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
