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KMID : 0385920200310020246
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Journal of the Korean Society of Emergency Medicine
2020 Volume.31 No. 2 p.246 ~ p.253
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Evaluation of pneumonia management effectiveness associated with internal medicine management changes in the emergency department: a retrospective cohort study using a historically controlled group
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Yoo Jung-Woo
Ryu Seung
Jeong Won-Joon
Cho Yong-Chul
Ahn Hong-Joon
Cho Seong-Wook
Oh Se-Kwang
Park Jung-Soo
Yoo Yeon-Ho
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Abstract
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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.
Method: 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.
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KEYWORD
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Door-to-treatment time, Length of stay, Pneumonia, Process assessment
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