1. Pneumonia Core Measure Antibiotic choice in immuno- competent ICU patients PHA Power Hour, Sep 2011 Nathan Spell, MD Chief Quality Officer, Emory University Hospital

2. Pneumonia Composite (% “Perfect Care”) 2

3. 3

4. Abx in immuno-competent ICU patients 4

5. Details about Emory University Hospital ICU’s 14-bed medical ICU receives most ICU-bound pneumonia patients Closed ICU – all admissions to the team Pulmonary – CC attendings with a PA and medical residents Most pneumonia/sepsis patients admitted via the Emergency Department, rather than transfers from other hospitals 5

6. Pre-2006-ish No standard order sets Initial dose of an antibiotic given in ED Residents wrote initial antibiotic orders upon arrival to ICU 6

7. 2007-ish Standard admission order set on paper Included section for ventilator orders Included section for sepsis treatment – Antibiotic selection for sepsis met criteria for pneumonia coverage 7

8. Spring 2010 – CPOE Hospital epidemiologist (ID physician) reviewed all order sets with antibiotics – Updated based on hospital antibiogram – Checked that PN and Sepsis orders met Core Measure criteria Attendings reviewed/approved Puts everything they want on one order set – MAKES LIFE EASIER FOR THE ORDERING PHYSICIAN 8

9. Physician buy-in Turned out to not be a problem ID “Consult in a can” Physician-driven changes Docs just want it to be easy Pneumonia Order set for outside the ICU has been little used in CPOE because physicians can just add med orders to the basic admission order set. Future work will address how to get better adoption of the disease-specific orders. 9

10. Questions? 10