Table 1.

QIs to measure appropriate antibiotic use in adult patients in the ED

Number	QI	Numerator description	Denominator description
QIs applicable in the ED
1a	antimicrobial therapy in adult patients with sepsis should be started intravenously	number of patients with sepsis who started with empirical systemic antimicrobial therapy intravenously	total number of patients with sepsis who started with empirical systemic antimicrobial therapy
2a	antimicrobial therapy should be started as soon as possible, preferably within 3 h in adult patients with severe sepsis and septic shock	number of patients with severe sepsis or septic shock who started with empirical systemic antimicrobial therapy within the first 3 h after the clinical diagnosis	total number of patients with severe sepsis or septic shock, who started with empirical systemic antimicrobial therapy
3	before starting antimicrobial therapy, at least two sets of blood cultures should be taken	number of patients from whom at least two blood cultures were taken before empirical systemic antimicrobial therapy was started	total number of patients who started with empirical systemic antimicrobial therapy
4	specimens for culture from suspected sites of infection should be taken when possibleb	number of patients from whom specimens for culture from suspected sites of infection were taken	total number of patients who started with empirical systemic antimicrobial therapy
5	an antibiotic plan should be documented in the case notes at the start of systemic antibiotic therapy (antibiotic plan is indication and name)	number of patients who started with systemic antibiotic therapy for whom an antibiotic plan was documented in the case notes	total number of patients who started with systemic antibiotic therapy
6	empirical systemic antimicrobial therapy (only choice of antimicrobial agent) should be prescribed according to the local (or national) guideline	number of patients who started with empirical systemic antimicrobial therapy according to the guideline	total number of patients who started with empirical systemic antibiotic therapy
7	first dose of systemic antibiotic therapy should be correctc	number of patients with a correct first dose	total number of patients who started with systemic antibiotic therapy

^aQIs 1 and 2 are only applicable to patients with sepsis (≥2 SIRS criteria) or septic shock.

^bRecommended microbiological testing for each site of infection is presented in Table S1 in Appendix S1.

^cAdjusted to the setting of the ED; even patients with renal dysfunction can generally be prescribed a one-time dose similar to that for a patient with normal kidney function; reducing the dose in patients with renal failure can even be harmful.³³