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Release Notes:
Measure Information Form
Version 2010B


Measure Information Form

Measure Set: Pneumonia(PN)

Set Measure ID: PN-3b

Performance Measure Name: Blood Cultures Performed in the Emergency Department Prior to Initial Antibiotic Received in Hospital

Description: Pneumonia patients whose initial emergency room blood culture specimen was collected prior to first hospital dose of antibiotics. This measure focuses on the treatment provided to Emergency Department patients prior to admission orders.

Rationale: Published pneumonia treatment guidelines recommend performance of blood cultures for all inpatients to optimize therapy. Improved survival has been associated with optimal therapy. In addition, the yield of clinically useful information is greater if the culture is collected before antibiotics are administered.

Type of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Number of pneumonia patients whose initial emergency room blood culture was performed prior to the administration of the first hospital dose of antibiotics
Included Populations: Not applicable

Excluded Populations: None

Data Elements:

Denominator Statement: Pneumonia patients 18 years of age and older who have an initial blood culture collected as an emergency department patient.

Included Populations: Discharges 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
  • 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 >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 day of or day after arrival
  • Patients enrolled in clinical trials
  • Patients received as a transfer from the emergency department of another hospital
  • Patients who have a final diagnosis/impression of pneumonia upon direct admit
  • Patients who had no diagnosis of pneumonia either as the ED final diagnosis/impression or direct admission diagnosis/impression
  • Patients who only received antibiotics prior to hospital arrival
  • Patients who do not receive any antibiotics within 24 hours after arrival.
  • Patients who do not receive a blood culture
  • Patients who do not have a blood culture collected in the ED prior to admission order
  • Patients who have a blood culture collected within 24 hours prior to hospital arrival
  • Patients discharged/transferred to another hospital for inpatient care on day of or day after arrival
  • Patients discharged/transferred to a federal health care facility on the day of or the day after arrival
  • Patients who left against medical advice or discontinued care on day of or day after arrival
  • Patients who expired on day of or day after arrival

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. 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.

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

  • To be part of the measure population, a patient must have received an antibiotic either during the hospitalization or within 24 hours prior to hospital arrival plus during the hospitalization. Measure specifications do not require documentation of the exact date and time of the antibiotic taken prior to hospitalization.
  • To be part of the measure population, a patient must be an Emergency Department patient and have a blood culture collected prior to an admission order.

Measure Analysis Suggestions: None

Sampling: Yes. For additional information see the Sampling 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.
  • 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

Measure Algorithm:

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Related Topics

Measure Information Form PN-3b
Specifications Manual for Joint Commission National Quality Core Measures (2010B)
Discharges 10-01-10 (4Q10) through 03-31-11 (1Q11)