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Antibiotic timeframe now six hours: Joint Commission
Physicians can use 'diagnostic uncertainty'
Previously, patients diagnosed with community-acquired pneumonia were to receive antibiotic administration within four hours of presentation. Now, The Joint Commission standards call for antibiotic administration within six hours.
The measure was changed because of concerns about unintended consequences of the performance measure. Hospitals were inappropriately giving antibiotics to patients who did not need them because they were trying to meet the four-hour measure, says Dale Bratzler, DO, MPH, medical director at the Oklahoma Foundation for Medical, the state's Quality Improvement Organization.
In addition to changes in timing, The Joint Commission will also now allow physicians to use a new data element, "diagnostic uncertainty," if the patients' diagnosis of pneumonia was not clear at arrival. Cases reflecting this data element will not be included in determining adherence to antibiotic timing standards.
Preliminary review of data from the third quarter of 2006 shows that about 90% of patients with pneumonia who are reviewed in this core topic receive antibiotics within six hours of arrival to the hospital, reports Bratzler. "It is at about 79% within four hours," he says.
However, timing is an important measure of quality and also serves as a catalyst for change in the way hospitals process patients, notes Bratzler. Many hospitals have addressed systems of care to improve patient flow in the emergency department, and reduce delays in diagnostic tests and treatment.
The decision was made by the CMS/Joint Commission Measures Maintenance Workgroup. "Many hospitals have been asking if CMS is going to follow suit of Joint Commission on this, but the changes were made jointly," says Bratzler.
In addition, the National Quality Forum's measures maintenance committee agreed unanimously to endorse antibiotics within six hours of hospital arrival. New guidelines for community-acquired pneumonia from the Infectious Diseases Society of America and the American Thoracic Society state that antibiotics should generally be given within six to eight hours after the patient's arrival, when the diagnosis is clear.
CMS and The Joint Commission have the data collection tools and algorithms in the April 2007 hospital manual for this newly endorsed measure, and eventually plan to drop data collection and analysis related to the previous requirement, adds Bratzler.
Hospitals really don't have to change anything about their data collection, says Bratzler. The performance rate for this measure is calculated by looking at the arrival time of the patient as compared to the documented time that the first antibiotic dose is administered.
"So we can calculate the performance on the antibiotic timing measure for essentially any time interval within 24 hours of arrival," he says. "Changing from four to six is simply a matter of us changing the computer algorithm to use a six-hour cut off."
[For more information, contact;
Dale W. Bratzler, DO, MPH, QIOSC, Medical Director, Oklahoma Foundation for Medical Quality, 14000 Quail Springs Parkway, Suite 400, Oklahoma City, OK 73134. Phone: (405) 840-2891, ext. 209. Fax: (405) 840-1343. E-mail: firstname.lastname@example.org.]