Crowded EDs lead to delays in sepsis treatment

Patients exhibiting sepsis upon arrival in crowded EDs waited an extra 47 minutes for antibiotics compared with those who presented at an empty ED, according to a retrospective cohort study of patients from four health care centers in Utah.

Results of the study by Ithan Peltan, MD, MSc, attending physician at Intermountain Medical Center and adjunct assistant professor of internal medicine at the University of Utah School of Medicine, and colleagues were presented at the American Thoracic Society International Conference.

“As emergency department workload increases, patients with sepsis are less likely to receive prompt antibiotics. In our study, the odds of administering antibiotics within 3 hours — the Medicare standard — were 70% lower for patients who presented to a crowded ED,” Peltan told Infectious Disease News.

In August, the CDC classified sepsis as a preventable medical emergency and said it begins outside of the hospital in 80% of cases. According to Peltan, each 1-hour delay in initiating antibiotic treatment leads to a 7% to 10% increase in the odds of dying from sepsis.

Peltan and colleagues included patients who exhibited sepsis on admission to an ICU at two community hospitals and two tertiary referral centers in Utah between July 2013 and December 2015. They determined ED workload based on occupancy rate and used multivariable regression to examine how it impacted treatment after adjusting for age, sex, comorbidities, nighttime ED arrival and indicators of illness severity.

Among 945 patients included in the study, 14% (n = 128) arrived when the ED was over capacity. These patients received antibiotics within 3 hours 72% of the time compared with 83% of the time for patients who arrived in uncrowded EDs.

In an adjusted analysis, Peltan and colleagues found patients presenting in a crowded ED waited an extra 47 minutes for antibiotics and were three times less likely to receive them within the recommended 3-hour time span.

“Automated sepsis alerts and order sets can facilitate sepsis diagnosis and treatment decisions for busy clinicians. Since we observed increases in door-to-antibiotic time well before EDs became overcrowded, however, it may be necessary to redesign sepsis care to circumvent competing demands on ED resources and clinicians,” Peltan said. “Care models using pre-hospital data to activate a multidisciplinary ED team are effective for other critical illnesses that require rapid treatment — including myocardial infarction and trauma — and could work well for sepsis.” – by Gerard Gallagher

Reference:

Peltan ID, et al. Abstract #5505. Presented at: American Thoracic Society International Conference; May 19-24, 2017; Washington.

Disclosure: Peltan reports no relevant financial disclosures.