Pneumonia and the 4-hour rule

The P4P guideline states that antibiotics for pneumonia should be administered within 4 hours of presentation in the ER. A study suggests that 90% compliance may not be possible, and wonders how much unnecessary antibiotics will be given to try and meet this metric. (via retired doc)

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Retiring Soon
This is such a piece of crap measure instituted by a bunch of bean counters. Now Everyone who presents with a cough, shortness of breath, or chest pain recieves a dose of Levaquin because if their discharge diagnosis happens to include “pneumonia” (even though it might have occured one week into the hospitalization). The bean counters track their visit all the way back to the ER and give them a ding.
Anonymous
God am I glad I can already see the light at the end of the retirement tunnel.
Anonymous
The only “everyone” who will be treated who should not have been treated are those with wimp chicken dropping doctors without the ethics to put their patients first. Providing unneeded unindicated treatment because of P4P is just another version of the age old sin of quacks providing inappropriate care for higher fees.
Anonymous
If you find yourself warping your best medical judgement to be compliant with guidelines for a few extra dollars, then you are already past your proper retirement date from this honorable profession however young you might be. If you are doing that, please find another occupation if you can’t afford to retire.
Retiring Soon
10:39 and 10:41,
I should clarify. THE HOSPITAL hired NP’s to do this at triage.
In addition, I have also had to answer to administration why I did not give ASA to an intubated patient, a beta blocker to a patient in 3rd degree heart block, or thrombolyse someone with a GIB.
That is why I am retiring soon.
Anonymous
Having to answer to peer review is a burden that we have to accept as part of a self-regulating profession. I have never answered to administration (not peers) on matters of medical judgement, and have sometimes been considered a problem for that reason. I think that we have to make a stand on some issues and understand that people and institutions, no longer considering us Gods, are going to make unreasonable demands to which we are ethically obliged to say “No”.
I don’t think you should have to have to defend yourself to administration on these matters, and agree that if you are, you ought to retire, find another hospital, move to a non-hospital practice, do something.
Retiring Soon
You certainly do not understand the Hopital Quality Initiative Program HPQI for CMS. Hospital based physicians have always had to deal with administration bean counters. HPQI is bean counters on steroids.
This is soon to come to almost all physicians in non-hospital settings as well with P4P. In July physician reporting of certain measures is voluntary to CMS. After that it will be “reduced pay for not performing (which means not meeting arbitrary measures)”. All insurance, HMO’s, PPO’s will then follow CMS lead. It is coming. It is coming. You can say that you aren’t going to play the bean counter game but you are going to get swept away my friend unless you are running a cash only practice.

Pneumonia and the 4-hour rule

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