Here are still more negative comments about the famous four hour rule.Patients with a discharge diagnosis of pneumonia are supposed to have received antibiotics within four hours to receive a gold star on their quality score sheet. This "quality indicator" is a core quality measure for CMS and JCAHO and according to Health Care Renewal at least in some hospitals may be one of the determinants of physician reimbursement.
To the quality police it may not matter if the rule they seek to enforce is not feasible which is what the above referenced article indicates.Unintended consequences of this rule have been written about by others
Rough cut, broad rules which ignore individual particulars and substitute a rule or algorithm for an individual expert's opinion and simplify things for ease of counting will naturally have consequences that the rule makers did not intend.
It is part of the mentality and hubris of the central planner to deny the expertise and value of the expert in the field familiar with case at hand.