Variation in Emergency Department Adherence to Treatment Guidelines for Inpatient Pneumonia and Sepsis: A Retrospective Cohort Study.
Journal
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
ISSN: 1553-2712
Titre abrégé: Acad Emerg Med
Pays: United States
ID NLM: 9418450
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
23
08
2018
revised:
12
10
2018
accepted:
17
10
2018
pubmed:
22
10
2018
medline:
31
3
2020
entrez:
22
10
2018
Statut:
ppublish
Résumé
Evidence-based clinical practice guidelines (CPGs) for the treatment of pneumonia and sepsis have existed for many years with multiple studies suggesting improved patient outcomes. Despite their importance, little is known about variation in emergency department (ED) adherence to these CPGs. Our objectives were to estimate variation in ED adherence across CPGs for pneumonia and sepsis and identify patient, provider, and environmental factors associated with adherence. This was a multicenter retrospective study using standard medical record review methods. The population consisted of consecutive adults hospitalized for pneumonia or sepsis (identified by discharge ICD-9 codes) at five Colorado hospitals (two academic, three community) who were admitted to the hospital from the ED and for whom the ED diagnosed or initiated treatment. The outcome measured was ED adherence to the CPG (primary) and in-hospital mortality (secondary). Hierarchical generalized linear models were used for analysis. Among 827 patients, ED care was 57% adherence to CPGs with significant variation in adherence across CPGs (sepsis 50%, pneumonia 64%, p < 0.001). Patients were less likely to receive adherent care if they presented with chief complaints that were associated but not typical of the diagnosis (odds ratio [OR] = 0.6, 95% confidence interval [CI] = 0.4-0.8), received an ED diagnosis that was not specific to the CPG (associated diagnosis OR = 0.3 [95% CI = 0.2-0.5]; unrelated diagnosis OR = 0.4 [95% CI = 0.2-0.6]) or presented to a community hospital (OR = 0.6, 95% CI = 0.4-0.9). ED CPG nonadherence was associated with higher in-hospital mortality (OR = 2.4, 95% CI = 1.2-4.8). Adherence to ED infectious CPGs for pneumonia and sepsis varies significantly across diseases and types of institutions with significant room for improvement, especially in light of a significant association with in-hospital mortality.
Identifiants
pubmed: 30343515
doi: 10.1111/acem.13639
pmc: PMC7676280
mid: NIHMS1643192
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
908-920Subventions
Organisme : AHRQ HHS
ID : F32 HS022400
Pays : United States
Organisme : Emergency Medicine Foundation
Pays : International
Informations de copyright
© 2018 by the Society for Academic Emergency Medicine.
Références
Ann Intern Med. 2009 Jan 6;150(1):19-26
pubmed: 19124816
Arch Intern Med. 2000 Jan 10;160(1):98-104
pubmed: 10632310
Chest. 2002 Aug;122(2):612-7
pubmed: 12171840
Ann Emerg Med. 2008 May;51(5):651-62, 662.e1-2
pubmed: 18272253
Lancet Infect Dis. 2012 Dec;12(12):919-24
pubmed: 23103175
Clin Infect Dis. 2005 Dec 15;41(12):1709-16
pubmed: 16288392
Ann Epidemiol. 2013 May;23(5):291-3
pubmed: 23522903
Crit Care. 2011;15(5):R229
pubmed: 21951322
Am J Med. 2001 Aug 15;111(3):203-10
pubmed: 11530031
Antimicrob Agents Chemother. 2007 Oct;51(10):3568-73
pubmed: 17682100
Am J Emerg Med. 2018 Aug;36(8):1397-1404
pubmed: 29402689
J Antimicrob Chemother. 2009 Dec;64(6):1123-5
pubmed: 19820250
Shock. 2012 May;37(5):463-7
pubmed: 22301605
Chest. 2007 Aug;132(2):425-32
pubmed: 17573521
Crit Care Med. 2006 Nov;34(11):2707-13
pubmed: 16943733
Clin Infect Dis. 2016 Sep 1;63(5):e61-e111
pubmed: 27418577
BMC Emerg Med. 2011 May 06;11:5
pubmed: 21548943
Acad Emerg Med. 2007 Oct;14(10):856-63
pubmed: 17898249
Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72
pubmed: 17278083
Crit Care Med. 2018 Jun;46(6):997-1000
pubmed: 29767636
Clin Infect Dis. 2014 Feb;58(3):330-9
pubmed: 24270053
Clin Ther. 2010 Feb;32(2):293-9
pubmed: 20206787
Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416
pubmed: 15699079
Crit Care. 2009;13(5):R143
pubmed: 19728879
Am J Emerg Med. 2010 Jul;28(6):689-93
pubmed: 20637384
Am J Respir Crit Care Med. 2011 Jun 1;183(11):1454-62
pubmed: 21239689
Intensive Care Med. 2015 Sep;41(9):1620-8
pubmed: 26109396
Lancet. 2007 Oct 20;370(9596):1453-7
pubmed: 18064739
Clin Infect Dis. 2007 Jan 15;44(2):159-77
pubmed: 17173212
Am J Med. 2001 Apr 15;110(6):451-7
pubmed: 11331056
Ann Emerg Med. 2018 Jan;71(1):10-15.e1
pubmed: 28789803
Am J Respir Crit Care Med. 2013 Jul 1;188(1):77-82
pubmed: 23631750
Crit Care. 2005;9(6):R764-70
pubmed: 16356225
Am J Med. 2006 Oct;119(10):865-71
pubmed: 17000218
Crit Care Med. 2007 Apr;35(4):1105-12
pubmed: 17334251
Chest. 2010 Sep;138(3):551-8
pubmed: 20173053
JAMA. 2000 Feb 9;283(6):749-55
pubmed: 10683053
Ann Emerg Med. 2014 Sep;64(3):292-8
pubmed: 24746846
Crit Care Med. 2010 Feb;38(2):367-74
pubmed: 20035219
Infect Dis Clin North Am. 2013 Mar;27(1):1-18
pubmed: 23398862
Pharmacoeconomics. 2004;22(11):751-7
pubmed: 15250752
Ann Epidemiol. 2004 Oct;14(9):669-75
pubmed: 15380798
Crit Care Med. 2015 Jan;43(1):3-12
pubmed: 25275252
Clin Infect Dis. 2004 Oct 1;39(7):955-63
pubmed: 15472846
Ann Intern Med. 2005 Dec 20;143(12):881-94
pubmed: 16365469
Intensive Care Med. 2014 Apr;40(4):572-81
pubmed: 24638939
Crit Care. 2015 Apr 06;19:139
pubmed: 25887596
Intensive Care Med. 2017 Mar;43(3):304-377
pubmed: 28101605
Ann Emerg Med. 1996 Mar;27(3):305-8
pubmed: 8599488
Antimicrob Agents Chemother. 2014 Sep;58(9):5262-8
pubmed: 24957843
Crit Care Med. 2008 Jan;36(1):296-327
pubmed: 18158437
Chest. 2014 Jul;146(1):22-31
pubmed: 24371840
Clin Infect Dis. 2015 Nov 1;61(9):1403-10
pubmed: 26223995
Crit Care Med. 2014 Aug;42(8):1890-8
pubmed: 24670937