When is a Scarlet Letter Really a Red Badge of Courage?: The Paradox of Percentage of Pneumonia Patients Receiving Antibiotics Within 4 Hours in Accordance with JCAHO and CMS Core Measures

Abstract

Effective October 2006, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Centers for Medicare and Medicaid Services (CMS) changed the inclusion criteria for identifying patients in the emergency department (ED) with community-acquired pneumonia who should receive antibiotics within 4 hours (PN-5b).1 The new criteria include both a final ED diagnosis of pneumonia (rather than an initial “working diagnosis”) and objective radiographic findings. These changes improve upon prior criteria that did not require objective data and presented emergency physicians the Hobson’s choice of administering antibiotics without sufficient evidence or being retrospectively criticized for failing to do so.