Objective: To evaluate the relationship between emergency department (ED) crowding and time to antibiotic treatment in pneumonia patients. The secondary objective was to look for other factors related to delayed antibiotic treatment.

Materials and Methods: The present study was a retrospective medical chart review between February 1 and June 30, 2015 of the patients aged 18 years and older with the ED diagnoses of pneumonia. The present study was performed in the ED of a tertiary care teaching hospital. One hundred seventy patients met the enrollment criteria. The patients were divided into ED crowded or non-crowded using the National Emergency Department Overcrowding Study tool for the main outcome of ED crowding and time to antibiotic treatment in pneumonia.

Results: In the 170 pneumonia patients, 117 patients (68.8%) came to the ED during a crowded shift. The characteristics of the patients were similar in both the crowded and non-crowded shifts. Of the 170 pneumonia patients, 51.8% had CURB-65 scores of 1 or 2. Patients who came to the ED during the crowded shift and non-crowded shift received antibiotics at the median times of 125 and 110 minutes, respectively (p=0.125). Delayed antibiotic treatments of more than four hours occurred in 19 patients (16.2%) during the crowded shift and in three patients (5.7%) in the non-crowded shift (p=0.098). Other factors related to time to antibiotics were the first doctor to see the patient (p=0.05), severity of disease (p<0.01), and admission type (p=0.01).

Conclusion: ED crowding was not related to time to antibiotic treatment in pneumonia patients. However, if the clinical conditions of the patients looked severe or the doctor who cared for the patients was an emergency medicine resident, the patients received early administration of antibiotics.

Keywords: Emergency department crowding, Pneumonia, Time to antibiotics

DOI: doi.org/10.35755/jmedassocthai.2021.04.11867

Received 10 September 2020 | Revised 20 December 2020 | Accepted 23 December 2020