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

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

J Korean Soc Emerg Med > Volume 31(2); 2020 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2020;31(2): 246-253.

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

Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea

Correspondence

Seung Ryu ,Tel: 042-280-6012, Fax: 042-280-6013, Email: rs0505@cnuh.co.kr,

Received: July 4, 2019; Revised: August 7, 2019 Accepted: August 20, 2019. Published online: April 30, 2020.

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.

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