I was discomforted by your publication of the article titled "Processes of Care, Illness Severity, and Outcomes in the Management of Community-Acquired Pneumonia at Academic Hospitals," which appeared in the second issue of September 2001. I strongly believe that the study was fatally flawed by the criteria chosen. Three of the chosen "processes" (antibiotic administration within 8 hours, blood cultures within 24 hours, and oxygen measurement within 24 hours) betray an unacceptable low level of performance. The time intervals permitted for performance of these procedures are so prolonged that they would be intolerably slow compared with the standards under which I and my fellow practitioners would allow our patients to be treated. There is every reason for a practicing physician to require all these processes to be completed within minutes of a patient's admission to a hospital. I would consider the inordinate delays allowed under the processes discussed to be suggestive of poor medical care.
Sanders KL. Dilatory Standards Are Below the Level of Care. Arch Intern Med. 2002;162(7):844-845. doi: