Blood culture in ED prior to initial antibiotic

What It Means
The percentage of patients with pneumonia who have a blood culture performed in the Emergency Department prior to receiving antibiotics in the hospital.

Why It Is Important
We know that when a patient with pneumonia has a blood culture (a test showing what disease organisms are present in the patient's blood) before receiving antibiotics, the physician has a much better idea how sick the patient really is and which antibiotic will be most helpful. If the antibiotics are given before the blood culture, the information the physician has to work with is not as clear and accurate.

Numerator Definition
Number of inpatients whose initial emergency room blood culture was performed prior to the administration of the first hospital dose of antibiotics.

Denominator Definition
Pneumonia patients 18 years of age and older who have an initial blood culture collected in the emergency department.

Denominator Excluded Populations

  • Patients who had no diagnosis of pneumonia either as the ED final diagnosis/impression or direct admission diagnosis/impression
  • Patients receiving Comfort Measures Only on day of or day after arrival
  • Patients less than 18 years of age
  • Patients who do not receive antibiotics or a blood culture
  • Patients who had no chest x-ray or CT scan that indicated abnormal findings within 24 hours prior to hospital arrival or anytime during this hospitalization
  • Patients with Cystic Fibrosis (Appendix A, Table 3.4)
  • Patients transferred to another acute care hospital or federal hospital on day of or day after arrival
  • Patients who expired on day of or day after arrival
  • Patients who left against medical advice on day of or day after arrival
  • Patients involved in clinical trials
  • Patients who only received antibiotics prior to hospital arrival
  • Patients who have a blood culture collected within 24 hours prior to hospital arrival
  • Patients who have a final diagnosis/impression of pneumonia upon direct admit
  • Patients who have a Length of Stay >120 days

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