Blood Cultures Performed Within 24 Hours Prior to or 24 Hours After Hospital Arrival for Patients Who Were Transferred or Admitted to the ICU Within 24 Hours of Hospital Arrival (NQF 0356)

eMeasure Name Blood Cultures Performed Within 24 Hours Prior to or 24 Hours After Hospital Arrival for Patients Who Were Transferred or Admitted to the ICU Within 24 Hours of Hospital Arrival eMeasure Id 7085C1F6-D52D-4093-9233-F5DE64D33C1A
Version number 1 eMeasure Set Id 5D4816C2-979E-4D0E-992C-8769333B3000
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Oklahoma Foundation for Medical Quality
Endorsed by National Quality Forum
Description Pneumonia patients transferred or admitted to the ICU within 24 hours of hospital arrival, who had blood cultures performed within 24 hours prior to or the day prior to arrival, the day of arrival, or within 24 hours after arrival to the hospital.
Copyright
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Although recommendations for blood cultures are controversial due to the overall low yield, they can have a significant impact on the care of an individual patient and are important for epidemiologic reasons, such as antibiotic susceptibility patterns used to develop treatment guidelines. The Joint IDSA/ATS Guidelines on the Management of Community-Acquired Pneumonia (CAP) in Adults recommend that certain patients with pneumonia should be investigated for specific pathogens that would significantly alter decisions regarding empirical therapy, when the presence of these pathogens is suspected (Mandell, 2007). 

The guidelines recommend that pretreatment blood samples for culture should be obtained from hospitalized pneumonia patients who are admitted to the Intensive Care Unit, have cavitary infiltrates, leukopenia, chronic severe liver disease, asplenia, pleural effusion, have a positive pneumococcal urinary antigen test (UAT), and have active alcohol abuse (Mandell, 2007). Pretreatment cultures are recommended because the yield of clinically useful information is greater if the culture is collected before antibiotics are administered. In a large retrospective study of blood cultures in pneumonia patients, Metersky et al demonstrated that when patients are selected appropriately, for example, those who are sicker or have comorbid conditions like liver disease, etc., the yield of blood culture pathogens was doubled for each risk factor. This measure, however, focuses on the actual performance of a culture for all patients who are ill enough to be admitted or transferred to the ICU within 24 hours of hospital arrival rather than restricting measurement to culture collection prior to antibiotics as the later provides an incentive for hospitals not to perform a culture in any patient who has already received antibiotics.
Clinical Recommendation Statement
The Joint IDSA/ATS Guidelines on the Management of Community-Acquired Pneumonia (CAP) in Adults recommend that certain patients with pneumonia should be investigated for specific pathogens that would significantly alter decisions regarding empirical therapy, when the presence of these pathogens is suspected
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Heffelfinger JD, Dowell SF, Jorgensen JH, Klugman KP, et al. Management of community-acquired pneumonia in the era of pneumococcal resistance: a report from the Drug-Resistant Streptococcus Pneumoniae Therapeutic Working Group. Archives of Internal Medicine. 2000, 160:1399-1408.
Reference
Mandell LA, Marrie TJ, Grossman RF, et al. Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Disease Society and the Canadian Thoracic Society. Clin Infect Dis 2000;31:383-421.
Reference
Mandell LA, Wunderink RG, Anzueta A, Bartlett JG, Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 March 1;44 Suppl 2:S27-72.
Reference
Metersky ML, Ma A, Bratzler DW, et al. Predicting bacteremia in patients with community-acquired pneumonia. Am J Respir Crit Care Med 2004; 169: 342-347
Definition
Initial Patient Population(s): All hospital discharges for pneumonia with hospital stays <= 120 days during the measurement year for patients age 18 and older at the time of hospital admission who are transferred or admitted to the ICU within 24 hours of hospital arrival
Definition
Denominator(s): Pneumonia patients 18 years of age and older who are transferred or admitted to the ICU within 24 hours of hospital arrival with an ICD-9-CM Principal Diagnosis Code of pneumonia OR ICD-9-CM Principal Diagnosis Code of septicemia or respiratory failure (acute or chronic) AND a secondary ICD-9-CM Other Diagnosis Code of pneumonia, and abnormal findings on chest x-ray or CT scan of the chest within 24 hours prior to hospital arrival or during the hospitalization.
Definition
Denominator Exclusion(s): Patients with Cystic Fibrosis (Appendix A, Table 3.4) Patients with Comfort Measures Only documented on day of or day after arrival. Patients enrolled in clinical trials. 
Patients received as a transfer from the emergency/observation department of another hospital. Patients received as a transfer from an inpatient or outpatient department of another hospital. Patients received as a transfer from an ambulatory surgery center. Patients who had no diagnosis of pneumonia either as the ED final diagnosis/impression or direct admission diagnosis/impression. Patients not transferred or admitted to the ICU within 24 hours of hospital arrival. Patients who have duration of stay less than or equal to one day.
Definition
Numerator(s): Number of pneumonia patients transferred or admitted to the ICU within 24 hours of hospital arrival who had blood cultures performed within 24 hours prior to or 24 hours after arrival at the hospital.
Definition
Denominator Exception(s): N/A
Guidance
The measurement period is one calendar year but the reporting period is 3 months as a calendar quarter; Q1 = Jan – Mar, Q2 = Apr – Jun, Q3 = Jul – Sep, Q4 is Oct – Dec. Patients for whom there are missing or inaccurate data (e.g., arrival time, medication administration, etc.) are considered to have failed the measure; the total number of patients with missing or erroneous (e.g., a time of 03:69 or a date of 10/26/2035) data (i.e., measure failures) must be reported with the results of the measure. 
	
General guidance: 

The measure criteria indicate scenarios in which the patient is admitted to the hospital directly (to ICU or Non-ICU locations) or the patient is admitted to one of these locations from the Emergency Department (ED). The calculation is to indicate the timing from arrival at the facility to the occurrence of an event. The arrival, therefore can be determined from the Emergency Department, the Non-ICU location, or the ICU location, whichever is the first location of contact between the patient and the facility. 

Exclusion element guidance: 

The exclusion for patients who are clinical trial participants is limited to patients participating in a clinical trial for pneumonia, the same condition as covered by the measure. Other clinical trials are not valid reasons for exclusions. 

Transfers from another hospital or an Emergency Department that is not part of the hospital's organization are excluded since care may have been delivered in the other setting. The measure as specified for abstraction allowed determination of other hospital or other hospital Emergency Departments by hospital billing number. Transfers within 1 day from those hospitals or Emergency Departments using the same facility number are not considered transfers for the exclusion section of this measure, those using other facility numbers are considered exclusions.
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012