Okay everybody, sit on uncle hat’s lap, and let him tell you a story.
once upon a time, a research study came out saying that giving antibiotics within 8 hours of a pneumonia patient arriving to a hospital improves mortality. well, medicare took that information and said “if 8 is great, 4 must be better!” so it mandated that all medicare patients diagnosed with pneumonia recieve antibiotics within 4 hours, or else the provider (hospital and doctor) get penalized. well, whenever medicare makes this kind of blanket policy, it usually isn’t too long before the rest of the third party payors (blue cross/shield, etc) follow suit.
well, after missing our targets for (time to antibiotics) in one quarter, my (former) boss said “if you suspect pneumonia, don’t delay, give antibiotics. and if you DON’T suspect pneumonia DO NOT WRITE ‘possible pneumonia’ on the chart! that way, if the timing is missed, it’s okay, because we did not suspect pneumonia, so it does not get sorted into the analysis.”
THE MORAL OF THIS STORY – if someone comes up with a way to be measured (a metric), SOMEONE ELSE will find a way to monkey with this metric, and make it look like something else is going on than what really is.
EPILOGUE – no one has yet (to my knowledge) performed studies to see if agressive adminsitration of antibiotics within 4 hours of patient arrival has INCREASED incidence of adverse reaction to antibiotics.