Reducing door-to-antibiotic time in community-acquired pneumonia: controlled before-and-after evaluation and cost-effectiveness analysis. Issue 1 (23rd August 2006)

• Record Type: Journal Article
• Authors: Barlow, Gavin; Nathwani, Dilip; Williams, Fiona; Ogston, Simon; Winter, John; Jones, Michael; Slane, Peter; Myers, Elizabeth; Sullivan, Frank; Stevens, Nicola; Duffey, Rebecca; Lowden, Karen; Davey, Peter
• Is Part Of: Thorax. Volume 62:Issue 1(2007)
• Page Start: 67
• Page End: 74
• Publication Date: 2006-08-23
• Subjects: A&E, accident and emergency -- AMAU, acute medical admissions unit -- BTS, British Thoracic Society -- CAP, community-acquired pneumonia -- CURB65, confusion, urea, respiratory, blood pressure, age >65; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thx.2005.056689
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: Practice guidelines suggest that all patients hospitalised with community-acquired pneumonia (CAP) should receive antibiotics within 4 h of admission. An audit at our hospital during 1999–2000 showed that this target was achieved in less than two thirds of patients with severe CAP. Methods: An experienced multidisciplinary steering group designed a management pathway to improve the early delivery of appropriate antibiotics to patients with CAP. This was implemented using a multifaceted strategy. The effect of implementation was evaluated using a controlled before-and-after study design over two winter seasons (November–April 2001–2 and 2002–3). Cost-effectiveness analyses were performed from the hospital's perspective. Results: The proportion of patients receiving appropriate antibiotics within 4 h of admission to hospital increased from 33% to 56% at the intervention site, and from 32% to 36% at the control site (absolute change adjusted for differences in severity of illness 17%, p = 0.035). The cost per additional patient receiving appropriate antibiotics within 4 h was £132 with no post-implementation evaluation, and £456 for a limited post-implementation evaluation. Simple modelling from the results of a large observational study suggests that the cost per death prevented could be £3003 with no post-implementation evaluation, or £16 632 with a limited post-implementation evaluation. Conclusions: The intervention markedly improved door-to-antibiotic time, albeit at considerable cost. It might still be a cost-effective strategy, however, to reduce mortality in CAP. Uncertainty about the cost effectiveness of such interventions is likely to be resolved only by a well-designed, cluster randomised trial.