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Specifications Manual for Joint Commission National Quality Measures (v2015A)
Home » Pneumonia (PN) » PN-3a

Release Notes:
Measure Information Form
Version 2015A

Measure Information Form

Measure Set: Pneumonia(PN)

Set Measure ID: PN-3a

Performance Measure Name: Blood Cultures Performed Within 24 Hours Prior to or 24 Hours After Hospital Arrival for Patients Who Were Transferred or Admitted to the ICU Within 24 Hours of Hospital Arrival

Description: Pneumonia patients transferred or admitted to the ICU within 24 hours of hospital arrival, who had blood cultures performed within 24 hours prior to or the day prior to arrival, the day of arrival, or within 24 hours after arrival to the hospital.

Rationale: Although recommendations for blood cultures are controversial due to the overall low yield, they can have a significant impact on the care of an individual patient and are important for epidemiologic reasons, such as antibiotic susceptibility patterns used to develop treatment guidelines. The Joint IDSA/ATS Guidelines on the Management of Community-Acquired Pneumonia (CAP) in Adults recommend that certain patients with pneumonia should be investigated for specific pathogens that would significantly alter decisions regarding empirical therapy, when the presence of these pathogens is suspected (Mandell, 2007). The guidelines recommend that pretreatment blood samples for culture should be obtained from hospitalized pneumonia patients who are admitted to the Intensive Care Unit, have cavitary infiltrates, leukopenia, chronic severe liver disease, asplenia, pleural effusion, have a positive pneumococcal urinary antigen test (UAT), and have active alcohol abuse (Mandell, 2007). Pretreatment cultures are recommended because the yield of clinically useful information is greater if the culture is collected before antibiotics are administered. In a large retrospective study of blood cultures in pneumonia patients, Metersky et al demonstrated that when patients are selected appropriately, for example, those who are sicker or have comorbid conditions like liver disease, etc., the yield of blood culture pathogens was doubled for each risk factor.

This measure, however, focuses on the actual performance of a culture for all patients who are ill enough to be admitted or transferred to the ICU within 24 hours of hospital arrival rather than restricting measurement to culture collection prior to antibiotics as the later provides an incentive for hospitals not to perform a culture in any patient who has already received antibiotics.

Type of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Number of pneumonia patients transferred or admitted to the ICU within 24 hours of hospital arrival who had blood cultures performed within 24 hours prior to or 24 hours after arrival at the hospital.
Included Populations: Not applicable

Excluded Populations: None

Data Elements:

Denominator Statement: Pneumonia ICU patients 18 years of age and older.

Included Populations: Discharges:
  • Who are transferred or admitted to the ICU within 24 hours of hospital arrival
  • With an ICD-9-CM Principal Diagnosis Code of pneumonia as defined in Appendix A, Table 3.1 OR ICD-9-CM Principal Diagnosis Code of septicemia or respiratory failure (acute or chronic) as defined in Appendix A, Tables 3.2, or 3.3
  • With an ICD-9-CM Other Diagnosis Code of pneumonia (Appendix A, Table 3.1)

Excluded Populations:
  • Patients less than 18 years of age
  • Patients who have a Length of Stay greater than 120 days
  • Patients with Cystic Fibrosis (Appendix A, Table 3.4)
  • Patients who had no chest x-ray or CT scan that indicated abnormal findings within 24 hours prior to hospital arrival or anytime during this hospitalization
  • Patients with Comfort Measures Only documented on day of or day after arrival
  • Patients enrolled in clinical trials
  • Patients received as a transfer from the emergency/observation department of another hospital
  • Patients received as a transfer from an inpatient or outpatient department of another hospital
  • Patients received as a transfer from an ambulatory surgery center
  • Patients who had no diagnosis of pneumonia either as the ED final diagnosis/impression or direct admission diagnosis/impression
  • Patients not transferred or admitted to the ICU within 24 hours of hospital arrival
  • Patients who have duration of stay less than or equal to one day

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical record documents. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunities for improvement at the point of care/service. However, complete documentation includes the principal or other ICD-9-CM diagnosis and procedure codes, which require retrospective data entry.

Model Validation:

Data Accuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: None

Sampling: Yes. Please refer to the measure set specific sampling requirements and for additional information see the Population and Sampling Specifications section.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:
  • Heffelfinger JD, Dowell SF, Jorgensen JH, Klugman KP, et al. Management of community-acquired pneumonia in the era of pneumococcal resistance: a report from the Drug-Resistant Streptococcus Pneumoniae Therapeutic Working Group. Archives of Internal Medicine. 2000, 160:1399-1408.
  • King MD, Whitney CG, Parekh F, Farley MM. Recurrent invasive pneumococcal disease: a population-based assessment. Clin Infect Dis 2003; 37:1029-36.
  • Mandell LA, Marrie TJ, Grossman RF, et al. Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Disease Society and the Canadian Thoracic Society. Clin Infect Dis 2000;31:383-421.
  • Mandell LA, Wunderink RG, Anzueta A, Bartlett JG, Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007 March 1;44 Suppl 2:S27-72.
  • Metersky ML, Ma A, Bratzler DW, et al. Predicting bacteremia in patients with community-acquired pneumonia. Am J Respir Crit Care Med 2004; 169: 342-347.
  • van der Eerden MM, Vlaspolder F, de Graaf CS, Groot T, Bronsveld W, Jansen HM. Comparison between pathogen directed antibiotic treatment and empirical broad spectrum antibiotic treatment in patients with community acquired pneumonia: a prospective randomised study. Thorax 2005; 60:672-8.

Measure Algorithm:

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Measure Information Form PN-3a
Specifications Manual for Joint Commission National Quality Measures (v2015A)
Discharges 01-01-15 (1Q15) through 09-30-15 (3Q15)