Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-16T07:29:10.716Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of an emergency department sepsis protocol on time to antibiotics in severe sepsis

Published online by Cambridge University Press:  21 May 2015

Marc Francis ,
Tom Rich ,
Tyler Williamson  and
Daniel Peterson
Marc Francis*
Affiliation:
Department of Emergency Medicine, Calgary Health Region, Calgary, Alta.
Tom Rich
Affiliation:
Department of Emergency Medicine, Calgary Health Region, Calgary, Alta.
Tyler Williamson
Affiliation:
Departments of Family Medicine and Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alta.
Daniel Peterson
Affiliation:
Division of Emergency Medicine, London Health Sciences Centre, London, Ont.
*
Department of Emergency Medicine, Foothills Medical Centre, Rm. C231, 1403-29th St. NW, Calgary AB T2N 2T9; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

We sought to evaluate the time to antibiotics for emergency department (ED) patients meeting criteria for severe sepsis before and after the implementation of an ED sepsis protocol. Compliance with published guidelines for time to antibiotics and initial empiric therapy in sepsis was also assessed.

Methods:

A retrospective chart review was conducted. Emergency department patient encounters with International Classification of Diseases codes related to severe infections were screened during a 3-month period before and after the implementation of a sepsis protocol. Encounters meeting criteria for severe sepsis were further assessed. The time to initiation of antibiotics was determined as well as the initial choice of antimicrobial therapy based on the presumed source of infection.

Results:

We reviewed 213 unique ED patient encounters meeting criteria for severe sepsis. Analysis of the period before implementation showed a median time from the time criteria for severe sepsis were met to delivery of antibiotics of 163 minutes (95% confidence interval [CI] 124 to 210 min). Analysis of the period after implementation of the protocol revealed a median time of 79 minutes (95% CI 64 to 94 min), representing an overall reduction of 84 minutes (95% CI 42 to 126 min). Before the implementation of the protocol, 47% of patients received correct antibiotic coverage for the presumed source of infection in compliance with locally published guidelines. After the initiation of the protocol, 73% received appropriate initial antibiotics, for an overall improvement of 26%.

Conclusion:

A guideline-based ED sepsis protocol for the evaluation and treatment of the septic patient appears to improve the time to administration of antibiotics as well as the appropriateness of initial antibiotic therapy in patients with severe sepsis.

Keywords

sepsissevere sepsisseptic shockemergency medicinequality improvementemergency department
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 4 , July 2010 , pp. 303 - 310
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

References

REFERENCES

1.Rivers, EP, McIntyre, L, Morro, DC, et al.Early and innovative interventions for severe sepsis and septic shock: taking advantage of a window of opportunity. CMAJ 2005;173:1054–65.Google Scholar
2.McIntyre, LA FD, Herbert, PC, Cook, DJ, et al.Are delays in the recognition and initial management of patients with severe sepsis associated with hospital mortality? Crit Care Med 2003;31[12(suppl)]:A75.Google Scholar
3.Angus, DC, Linde-Zwirble, WT, Lidicker, J, et al.Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303–10.CrossRefGoogle ScholarPubMed
4.Lundberg, JS, Perl, TM, Wiblin, T, et al.Septic shock: an analysis of outcomes for patients with onset on hospital wards versus intensive care units. Crit Care Med 1998;26:1020–4.CrossRefGoogle ScholarPubMed
5.Dellinger, RP, Carlet, JM, Masur, H, et al.Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32:858–73.Google Scholar
6.Dellinger, RP, Carlet, JM, Masur, H, et al.Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med 2004;30:536–55.CrossRefGoogle ScholarPubMed
7.McCabe, WR, Jackson, GG. Gram negative bacteremia. Arch Intern Med 1962;110:847–55.Google Scholar
8.Leibovici, L, Shraga, I, Drucker, M, et al.The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med 1998;244:379–86.Google Scholar
9.Ibrahim, EH, Sherman, G, Ward, S, et al.The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcome in the ICU setting. Chest 2000;118:146–55.Google Scholar
10.Bochud, PY, Bonten, M, Marchetti, O, et al.Antimicrobial therapy for patients with severe sepsis and septic shock: an evidence-based review. Crit Care Med 2004;32(suppl):S495–512.CrossRefGoogle ScholarPubMed
11.Dellinger, RP, Levy, AIM, Carlet, JM, et al.Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008;36:296–327.Google Scholar
12.Green, RS, Djogovic, D, Gray, S, et al.Canadian Association of Emergency Physicians Sepsis Guidelines: the optimal management of severe sepsis in Canadian emergency departments. CJEM 2008;10:443–59.CrossRefGoogle ScholarPubMed
13.Bone, RC, Balk, R, Cerra, FB, et al.ACCP/SCCM consensus conference: definitions for sepsis and organ failure and guidelines for use of innovative therapies in sepsis. Chest 1992;101:1644–55.Google Scholar
14.Bonett, DG, Price, RM. Statistical inference for a linear function of medians: confidence intervals, hypothesis testing and sample size requirements. Psychol Methods 2002;7:370–83.CrossRefGoogle ScholarPubMed
15.Rivers, E, Nguyen, B, Havstad, S, et al.Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368–77.Google Scholar
16.Houck, PM, Bratzler, DW, Nsa, W, et al.Timing of antibiotic administration and outcomes for medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med 2004;164:637–44.Google Scholar
17.Meehan, TP, Fine, JM, Krumholz, HM, et al.Quality of care, process and outcomes in elderly patients with pneumonia. JAMA 1997;278:2080–4.Google Scholar
18.Kumar, A, Roberts, D, Wood, KE, et al.Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34:1589–96.CrossRefGoogle ScholarPubMed
19.Garnacho-Montero, J, Garcia-Garmendia, JL, Barrero-Almodovar, A, et al.Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 2003;31:2742–51.CrossRefGoogle Scholar