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Stephanie Natsch, PharmD; Bart J. Kullberg, MD; Jacques F. G. M. Meis, MD; Jos W. M. van der Meer, MD

Arch Intern Med. 2000;160:1317-1320.

Objective  To examine whether combined interventions improve the timely administration of antibiotic therapy and acquisition of material for culture from patients admitted to the emergency department with a serious infectious disease.

Methods  Guidelines and educational programs were developed to facilitate timely antibiotic administration: guidelines on handling patients with serious infections and on ordering immediate treatment, guidelines on obtaining culture samples, lectures to medical and nursing staff, improvement of availability of antibiotics in the emergency department, and removal of financial restraints on stocking and ordering of antibiotics. Fifty consecutive patients were evaluated after this series of interventions and compared with the results in 50 patients evaluated before the interventions. The interval from presentation to the emergency department until the administration of antibiotics, number of samples taken for microbiological investigations, and number of patients receiving a first dose of antibiotic at routinely scheduled drug distribution rounds were evaluated.

Results  The median time to the initial dose of antibiotics administered decreased from 5.0 hours to 3.2 hours (P=.04). The number of blood cultures obtained did not change. The percentage of sputum cultures obtained increased from 28% to 50%, and the percentage of urine cultures obtained increased from 50% to 100%. The percentage of patients whose first dose of antibiotic was delayed until a routinely scheduled drug distribution round decreased from 54% to 32% (P=.03).

Conclusions  Combined interventions to expedite diagnostic and therapeutic actions through directed clinical practice guidelines and organizational measures are successful. This may lead to a substantial quality improvement in the process of care.

From the Departments of Internal Medicine (Drs Natsch, Kullberg, and van der Meer) and Medical Microbiology (Dr Meis), University Hospital Nijmegen, Nijmegen, the Netherlands. Dr Natsch is now with the Department of Clinical Pharmacy.

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