Atopic and non-atopic eczema

Delays in intensive care unit (ICU) admission are associated with higher mortality in community acquired pneumonia (CAP). (Phua J, Eur Resp J 2010;36:826). In 2008 we employed minor severity criteria from the 2007 IDSA/ATS guidelines plus point of care lactate to identify high risk patients in the emergency department (ED) for rapid resuscitation and direct admission to the ICU. (Phua J, Thorax 2009;64:598) This was associated with reduced mortality in severe CAP, without increasing ICU admission rates. (Lim TK, Int. Forum on Quality & Safety in Healthcare 2012). Intervention: In July 2010 we implemented peer-to-peer feedback(p2p) on severe CAP management between ED & ICU teams to improve teamwork and safety. (Hudson DW, et al Am J Med Qual. 2011 Dec 27) Results: From Jul 2010-Dec 2011 we admitted 243 patients with severe CAP in our ICU. ICU admission were delayed in 36% and hospital deaths 22.2%. Delays in ICU admission increased from 31% in 2010 to 40% in 2011. Nevertheless, there was a small drop in overall mortality (25.5% to 20%) mostly in patients directly admitted to ICU which fell from 26.5% to 17.2%. Mortality in delayed ICU admissions was stable (23.9% to 23.3%). Adherence to the resuscitation bundle was high in 2010: point of care lactate test 91%, antibiotics 97%, intravenous fluids 95% & vaso-pressors 100%. But it fell in 2011 to 84%, 80%, 98% & 86% respectively. Conclusions: In the management of severe CAP p2p was associated with reduction in mortality without increasing early/direct ICU admissions rates. Timely and sustained p2p feedback may be required to maintain a high degree of adherence to resuscitation bundles and to further improve patient outcomes in severe CAP.