I’m not surprised about this:

Elderly patients hospitalized for suspected pneumonia may be getting antibiotics before their doctor is certain about the diagnosis, a new study suggests.

Among health-care professionals, the practice is known as “shoot first and ask questions later.” And the premature use of antibiotics for elderly patients with suspected pneumonia is often done to meet federal performance standards that dictate giving the drugs within four hours of arrival at a hospital.

“Some patients are probably getting antibiotics inappropriately in an attempt to deliver antibiotics quickly to meet externally mandated standards,” said lead study author Dr. Mark L. Metersky, a professor of medicine at the University of Connecticut School of Medicine. . .

. . . For hospital officials and those who establish standards of care, the message is that “100 percent [antibiotic adherence within four hours] is not an appropriate goal, because it leads to inappropriate care,” Metersky said.

“Seventy-five or 80 percent is probably more appropriate,” he said.

This will happen when you use a blunt instrument, like global performance measures, to improve quality.