We were interested to read the study by Barlow et al.¹ We also audited door-to-antibiotic time in community acquired pneumonia. An initial audit in January 2005 (n = 83) showed a door-to-antibiotic time of 7 hours 37 minutes with a delay from seeing the doctor to receiving antibiotics of 5 hours 45 minutes. 36% of patients had a delay of >8 hours. The main reason identified was that, if patients arrived on the ward after a drug round, they would not receive any drugs until the next scheduled drug round. For patients admitted at night this could mean a delay of up to 8 hours. The data were shared with doctors in the Accident and Emergency department who were asked to prescribe the first dose of antibiotic as a “stat” once-only dose on the front of the drug chart, and then to give the chart to the nurse in charge of the patient. We re-audited in October 2006 (n = 34). The delay in doctor-to-antibiotic time had fallen to 3 hours 15 minutes, with the delay for intravenous antibiotics being 2 hours 11 minutes—a reduction of 2 hours 30 minutes. 3% of patients waited >8 hours for their antibiotic and 74% received their antibiotic within 4 hours.

This simple intervention, at no cost, greatly reduced the delay in patients receiving antibiotic therapy. It is likely that this is also an issue in other infections and we believe that there is no reason why this should not be standard practice in Accident and Emergency departments and on admission wards.