Source: International Congress 2014 – Different interesting issues in respiratory infections: 1
Disease area: Respiratory critical care, Respiratory infections

Abstract

Background: It is widely assumed that Out of hours (OOH) care is inferior to that given during the standard working hours (SWH) of 9-5 Monday to Friday.Aims and Objectives: We aimed to establish whether there was a difference in the care received by pneumonia patients by looking into patients admitted with community acquired pneumonia (CAP) and hospital acquired/aspiration pneumonia (non-CAP) during SWH and OOH.Methods: We undertook a retrospective audit into the initial management of patients admitted to our hospital with a primary diagnosis of CAP and non-CAP, and died during their hospital stay over a 9 month period. We assessed the quality of care by asking 3 key questions; a) Was severity assessment (CURB65 in CAP patients) documented? b) Was an appropriate initial antibiotic, based on hospital formulary, prescribed? c) What was the length of stay (LOS) before demise?Results: 148 patients mean (range) age 80.2 (40-101) died of pneumonia , out of which 89 had CAP and 59 non-CAP. The other results are shown in table 1.

Table 1

	SWH patients	OOH patients
CAP patients	35	54
Non-CAP patients	18	40
CURB65 done (%)	68	59
Correct antibiotics CAP (%)	40	37
Correct antibiotics Non-CAP (%)	72	82
LOS (days)	5.8	5.7

Conclusions: Adherence to antibiotic prescription for CAP was poor for both SWH and OOH, as most patients were treated for non-CAP sepsis. Severity assessment for CAP is less likely OOH, however this does not translate into a decreased adherence to our antibiotic formulary or survival time. Extra effort should be made to train juniors at the front-end of the hospital ie. A&Es and acute medicine departments to adhere to antibiotic policy in all patients with CAP.

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Citations should be made in the following way:
L. Harding, E. Davies, R. Sundar, I. Aziz (Wigan, United Kingdom). Out of hours vs standard working hour care; a retrospective comparison of pneumonia care. Eur Respir J 2014; 44: Suppl. 58, 2549

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