JCAHO takes the easy way out, and expands the antibiotic-pneumonia window to six hours. retired doc is not impressed:

Reacting to an outpouring of criticism and valid complaints about the simplistic four hour pneumonia rule the Joint Commission (aka JCAHO) emphatically demonstrated that they did not get the point and moved to correct the problem by increasing the time to six hours. They also amended the original rule by adding a diagnostic category called “diagnostic uncertainty”, cases designated as such would not be included in the emergency department report card.

Predictably, some advocates of the rule complained that this category will set the stage for cheating.If the six hour clock has run out,those devious ER docs can place the case in that category.You just can’t trust doctors, you have to watch them all the time.