Reporting hospitals' antibiotic timing in pneumonia: adverse consequences for patients?

To determine whether publicly reporting hospital scores on antibiotic timing in pneumonia (percentage of patients with pneumonia receiving antibiotics within 4 hours) has led to unintended adverse consequences for patients.

Retrospective analyses of 13,042 emergency department (ED) visits by adult patients with respiratory symptoms in the National Hospital Ambulatory Medical Care Survey, 2001-2005.

Rates of pneumonia diagnosis, antibiotic use, and waiting times to see a physician were compared before and after public reporting, using a nationally representative hospital sample. These outcomes also were compared between hospitals with different antibiotic timing scores.

There were no differences in rates of pneumonia diagnosis (10% vs 11% of all ED visits, P = .72) or antibiotic administration (34% vs 35%, P = .21) before and after antibiotic timing score reporting. Mean waiting times to be seen by a physician increased similarly for patients with and without respiratory symptoms (11-minute vs 6-minute increase, respectively; P = .29). After adjustment for confounders, hospitals with higher 2005 antibiotic timing scores had shorter mean waiting times for all patients, but there were no significant score-related trends for rates of pneumonia diagnosis or antibiotic use.

Despite concerns, public reporting of hospital antibiotic timing scores has not led to increased pneumonia diagnosis, antibiotic use, or a change in patient prioritization.