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Pneumonia
How Do We Compare?
What is pneumonia?
| Pneumonia - Quality Measures | ||||
|---|---|---|---|---|
| MEASURE: | MEMORIAL RESULTS Oct-Dec 2007 (Actual/Total) |
COLORADO AVERAGE Jul 2006-Jun 2007‡ |
NATIONAL AVERAGE Jul 2006-Jun 2007‡‡ |
TOP 10% NATIONAL MINIMUM SCORE Jul 2006-Jun 2007† |
| Met all measures | 63.8% (95/149) |
No data available | No data available | No data available |
| Blood oxygen assessment |  100% (124/124) |
100% | 100% | 100% |
| Pneumococcal vaccination |  78.2% (61/78) |
81% | 81% | 96% |
| Timing of blood cultures in the emergency department |  94.3% (83/88) |
91% | 90% | 97% |
| Timing of initial antibiotic administration (within 4 hours) |  73.3% (66/90) |
84% | 81% | 93% |
| Smoking cessation |  100.0% (41/41) |
92% | 92% | 100% |
KEY:
(‡) This is the most current data available for average Colorado hospital quality performance according to the Centers for Medicare and Medicaid Services.
(‡‡) This is the most current data available for average national hospital quality performance according to the Centers for Medicare and Medicaid Services.
(†) This is the most current data available for the minimum quality performance score of any national top 10% hospital according to the Joint Commission.
NOTE: Memorial results are highlighted in the blue column of data and annotated with one of the following quality indicators:
= Achieved the best possible results
= Above national average performance
= At or near national average performance
= Below national average performance
What is pneumonia?
Pneumonia is an inflammation of the lung or surrounding tissue. It generally involves consolidation of the affected parts, with the air sacs (alveoli) being filled with waste from the offending agent. It can be caused by bacteria, viruses, chemicals, trauma or ingested material that enters the trachea by way of the esophagus.
Community-acquired and ventilator-associated pneumonia (VAP) are similar, but ventilator-associated pneumonia is generally more severe and requires vigilant preventive efforts by intensive care unit staff members who care for patients on ventilators.
What does “met all measures” mean?
This quality measure indicates the percentage of patients that successfully received all the pneumonia quality measures they were qualified to receive.
What is a blood oxygen assessment and why is it important?
Pneumonia is an inflammation of the lungs caused by bacteria, viruses, or irritants. It is a serious infection that fills the lungs with fluid making it difficult to breathe.
When the lungs contain fluid it reduces the amount of oxygen in the blood, which can have a negative effect on other organs such as the heart and brain. The Joint Commission recommends blood oxygen level assessment for hospitalized persons with suspected pneumonia.
Blood oxygen is often checked first by using pulse oximetry (a small clip attached to the finger or earlobe). It is often necessary to collect arterial blood in addition to the pulse oximetry test; this test is called arterial blood gases or ABGs.
Arterial blood is checked for oxygen, carbon dioxide, bicarbonate, and acid base balance or pH. Timely blood oxygen assessment can lead to rapid treatment and improved patient outcomes. The American Thoracic Society (ATS) also endorses oxygenation assessment for routine diagnostic testing in patients with suspected pneumonia.
What is a pneumococcal vaccination and why is it important?
Strong preventive efforts are essential for reducing pneumonia-related death and disability among high-risk groups such as those who are elderly, diabetic, or those with weakened immune systems. Others with chronic conditions such as heart, liver, or kidney disease, or cancer should also be considered for pneumococcal vaccination according to the Centers for Disease Control and Prevention (CDC). The Joint Commission, in conjunction with the Hospitals Quality Alliance (HQA) and the Centers for Medicare and Medicaid Services (CMS), recommends pneumococcal vaccination for persons at high risk for developing pneumonia.
The Infectious Diseases Society of America (IDSA) recommends pneumococcal vaccination for persons with chronic conditions such as heart failure, diabetes, emphysema (chronic lung disease), cirrhosis (liver disease) and alcoholism. Persons greater than 65 years of age who are in good health are also encouraged to receive the pneumococcal vaccine. Re-vaccination is generally not required for persons who receive the initial vaccination at age 65 or older. Persons who are vaccinated before the age of 65 should be re-vaccinated every five years according to the CDC's recommended adult immunization schedule. Your physician may recommend a different vaccination schedule to meet your individual needs.
What is blood cultures timing and why is it important?
With bacterial pneumonia it is important to determine if bacteria are present in the blood or urine, and to identify appropriate antibiotics to treat the bacteria. Blood cultures are tests that detect microorganisms present in the blood. A sample of blood is kept in a controlled temperature environment on a culture plate for several days to allow microorganisms to grow and be identified. The Joint Commission recommends blood cultures prior to antibiotic administration.
There is also a new urine test for pneumonia that is recommended by the Infectious Diseases Society of America (IDSA). The urine test takes only 15 minutes for results, whereas it may take days for blood culture results.
What is timing of antibiotic administration and why is it important?
Fever and chills are common in persons who develop pneumonia, with the temperature rising to as high as 106 degrees. Other symptoms, such as rust-colored sputum, pain associated with breathing, weakness, and shortness of breath, are also common with pneumonia. With antibiotic therapy, fever and related symptoms usually begin to subside in 2 to 3 days, as the pneumonia-causing bacteria are reduced in number. Careful antibiotic selection is vital in order to penetrate the specific bacteria that caused the pneumonia (Porth, C. M. (Ed.). (2005). Pathophysiology: Concepts of Altered Health States. Philadelphia: Lippincott Williams & Wilkins).
Multiple studies have demonstrated improved survival in persons with pneumonia who receive antibiotics in a timely manner. A study in the Archives of Internal Medicine (March 2002: 162 (6); 682-688) indicates that starting antibiotics in the emergency room, after careful consideration of which antibiotic to use, can also reduce the number of days a person is hospitalized.
A later study of 18,209 Medicare patients with community acquired pneumonia, which was reported in the Archives of Internal Medicine (March 2004:164 (6); 637-644), demonstrates shorter length of stay, reduced death and lower Hospitals cost for patients who receive antibiotics within 4 hours.
Why should persons with pneumonia receive smoking cessation advice?
Smoking has been identified as the strongest risk factor for pneumococcal pneumonia in healthy, non-elderly adults according to the New England Journal of Medicine, (March 2000: 342 (10); 681-689). Being admitted to the Hospital for a smoking-related illness can help to motivate people who smoke to quit.
The Joint Commission in conjunction with the Hospitals Quality Alliance (HQA) and the Centers for Medicare and Medicaid Services (CMS), recommend smoking cessation counseling for eligible persons with pneumonia.
The good news about the added health risk from smoking is that it is reduced when the person who smokes decides to quit. Not smoking helps the body to heal and improves overall health, but quitting can be difficult due to the addictive qualities of nicotine, one of the drugs ingested during smoking. Smokers, therefore, often require support and counseling. Helpful tips on quitting smoking from the National Cancer Institute are available at Smokefree.gov.
RELATED INFORMATION:
Agency for Healthcare Research and Quality (AHRQ)
www.ahrq.gov
American Board of Medical Specialties
www.abms.org
American Thoracic Society (ATS)
www.thoracic.org
Centers for Disease Control and Prevention (CDC)
www.cdc.gov
Centers for Medicare and Medicaid Services (CMS)
www.cms.hhs.gov
Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample
http://hcup.ahrq.gove/HcupNet.asp
Infectious Diseases Society of America (IDSA)
www.idsociety.org
Joint Commission
www.jointcommission.org
Smokefree.gov
www.smokefree.gov