Lengthy Wait for Antibiotics Can Endanger Sepsis Patients in Crowded EDs

May 25th, 2017

A crowded emergency department can be a dangerous place to be if you have sepsis according to a new study presented recently at the 2017 American Thoracic Society International Conference.

Researchers from the Intermountain Medical Center and University of Utah determined that patients with the life-threatening complication of an infection waited almost 50 minutes longer before receiving antibiotics in a crowded ED, compared with one without an overflowing waiting room.

"Prompt initiation of appropriate antibiotics is the cornerstone of high-quality sepsis care, a fact emphasized in Medicare quality measures and international guidelines," notes Ithan Peltan, MD, MSc. "I wanted to understand how strains on hospital resources influence timely antibiotics."

The answer is critically important; Peltan found that each one-hour delay in antibiotics was associated with a 7% to 10% increase in sepsis mortality rates.

For the study, researchers reviewed medical records of patients admitted to an intensive care unit after being treated in the EDs of two community hospitals and two tertiary referral centers in Utah between July 2013 and December 2015. All patients had exhibited sepsis symptoms on ED presentation.

ED crowding was determined by the ratio of registered patients to available beds. An ED was deemed crowded when the occupancy rate was ≥ 1.

Of 945 patients included in the study, 128 (14%) showed up at an overcrowded ED. Results indicate that antibiotics were administered to patients within three hours 83% of the time when the ED was uncrowded but only 72% of the time when the facility was backed up.

The adjusted analysis suggested that sepsis patients presenting to a crowded vs. an empty ED had to wait an additional 47 minutes for antibiotics. They also tripled their risk of not receiving antibiotics within the three-hour window recommended by Medicare and international guidelines.

"Our findings suggest adequate staff and diagnostic resources are critical to effective sepsis care," Peltan explains. "Hospitals should also consider sepsis care reorganization to bypass competing demands on clinicians and diagnostic resources."

How can that be done? “In many emergency departments, protocols coupling pre-hospital notification and a multi-disciplinary rapid response team help ensure time-dependent therapies for stroke, heart attack, and trauma patients. I suspect similar protocols could improve timely care for sepsis,” he notes.