Improving Door-to-Antibiotic Time in Severely Septic Emergency Department Patients

• Published in: The Journal of emergency medicine 2012-04, Vol.42 (4), p.462-469
• Main Authors: Hitti, Eveline A., MD, Lewin, John J., PharmD, BCPS, Lopez, Jose, MD, Hansen, Jonathan, MD, Pipkin, Michael, MD, Itani, Taha, MPH, Gurny, Paul, MBA, MS
• Format: Article
• Language: English
• Subjects: Adult; Anti-Bacterial Agents - administration & dosage; antibiotics; automated dispensing cabinet; Emergency; emergency department; Emergency Service, Hospital - statistics & numerical data; Female; Humans; Logistic Models; Male; Practice Guidelines as Topic; Retrospective Studies; sepsis; Sepsis - drug therapy; Time Factors; timing
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2011.05.015

Abstract Background The Surviving Sepsis Campaign (SSC) guidelines recommend that broad-spectrum antibiotics be administered to severely septic patients within 3 h of emergency department (ED) admission. Despite the well-established evidence regarding the benefit of timely antibiotics, adoption of the SSC recommendation into daily clinical practice has been slow and sporadic. Study Objective To study the impact of storing broad-spectrum antibiotics in an ED automated dispensing cabinet (ADC) on the timeliness of antibiotic administration in severely septic patients presenting to the ED. Methods Retrospective observational study of timeliness of antibiotic administration in severely septic patients presenting to a community ED before and after adding broad-spectrum antibiotics to the ED ADC. Data on 56 patients before and 54 patients after the intervention were analyzed. The primary outcome measure was mean order-to-antibiotic time. Secondary outcome measures included mean door-to-antibiotic time and percentage of patients receiving antibiotics within 3 h. Results The final analysis was on 110 patients. Order-to-antibiotic administration time was reduced by 29 min post-intervention (55 min vs. 26 min, 95% confidence interval [CI] 12.5–45.19). Mean door-to-antibiotic time was also reduced by 70 min (167 min vs. 97 min, 95% CI 37.53–102.29). The percentage of severely septic patients receiving antibiotics within 3 h of arrival to the ED increased from 65% pre-intervention to 93% post-intervention (95% CI 0.12–0.42). Conclusion Storing key antibiotics in an institution’s severe sepsis antibiogram in the ED ADC can significantly reduce order-to-antibiotic times and increase the percentage of patients receiving antibiotics within the recommended 3 h of ED arrival.