J Korean Soc Emerg Med.  2020 Apr;31(2):246-253.

Evaluation of pneumonia management effectiveness associated withinternal medicine management changes in the emergency department:a retrospective cohort study using a historically controlled group

• Yoo JW
• Ryu S
• Jeong WJ
• Cho YC
• Ahn HJ
• Cho SW
• Oh SK
• Park JS
• Yoo YH

Abstract

Objective
In Korea, many hospitals have recently changed the process of internal medicine management in the emergency department (ED) because of reduced manpower, raising concerns regarding the decreased quality of medical care. The process of medical management in the ED was streamlined to resolve the reduced manpower. Thus, this study compared the pneumonia treatment effectiveness before and after the process changes.
Methods
This study included patients who were diagnosed with pneumonia in the ED and hospitalized from January 2014 to December 2016. They were divided into two groups based on before and after the changes. The disease severity, management adequacy, and prognosis were compared using the initial quick sequential organ failure assessment score (qSOFA), systemic inflammatory response syndrome criteria (SIRS), CURB-65 score, door-to-antibiotic time (DAT), length of stay (LOS), hospitalization period (HP), and in-hospital mortality, were collected retrospectively from the medical records.
Results
The qSOFA, SIRS, and CURB-65 scores did not differ between the two groups. The median (interquartile range) DAT, LOS, and HP were reduced after the process changes: DAT (160.0 minutes [111.0-230.0] vs. 120.0 minutes [74.0-175.0], P<0.001), LOS (7.6 hours [4.8-15.8] vs. 4.7 hours [3.2-6.8], P<0.001), and HP (9.0 days [6.0-16.0] vs. 8.0 days [5.0-15.0], P=0.011). On the other hand, the in-hospital mortality was similar in the two groups (14.1% vs. 11.2%, P=0.162).
Conclusion
The DAT, LOS, and HP decreased after the process changes, but the in-hospital mortality did not worsen. This shows that pneumonia management in the ED was not compromised, but rather improved, after the changes.

Keyword

Door-to-treatment time; Length of stay; Pneumonia; Process assessment