Examining the association between triage streamed treatment location and time to appropriate antibiotics in emergency department patients with septic shock

Abstract

Objective: Early recognition and treatment for sepsis is critical in improving patient outcomes. The present study sought to examine whether triage location was associated with time to appropriate antibiotics in a cohort of ED patients with septic shock. Methods: Septic shock patients were identified from a database of ED patients admitted with infection. Demographic, clinical and outcome data were reported by triage location. Time to event analyses sought to identify the association between triage location and time to appropriate antibiotic. Secondary outcome variables included ED and hospital length of stay (LOS), 30-day mortality, and ICU admission. Results: Time to appropriate antibiotic administration was longer for those patients triaged to lower acuity (242 min) compared to higher acuity (98 min, P < 0.01) locations. After adjustment for severity of illness, hospital LOS, ED LOS and 30-day mortality were similar regardless of the triaged location. Admission to ICU was lower for patients triaged to lower (7.3%) compared to higher (47.3%) acuity treatment locations. Conclusions: We identified a subgroup of septic shock patients triaged to a lower acuity treatment location who received significant delays to antibiotics. This research area deserves closer examination to potentially recognise septic shock earlier in the continuum.

Appropriateness of antibiotic prescribing for patients with sepsis in rural hospital emergency departments

“…Ceftriaxone and gentamicin were frequency underdosed, which is consistent with results from other studies 14–16 . Other indices of appropriate investigations and therapy such as blood culture collection rates were mostly consistent with established guidelines 17 and previous studies 12,18–20 . Most patients had a serum lactate measured.…”

“…[14][15][16] Other indices of appropriate investigations and therapy such as blood culture collection rates were mostly consistent with established guidelines 17 and previous studies. 12,[18][19][20] Most patients had a serum lactate measured. In-hospital mortality rates were also consistent with previous studies in Australian hospitals.…”

Risk classification and door-to-antibiotic time in patients with suspected sepsis

“…Other studies also showed that the time for antibiotic administration was shorter in patients classified as having higher priority, when compared to the others ( 26 - 27 ) . Furthermore, patient classification for lower priorities of care has been shown to be an independent risk factor for delay in administering the first dose of antibiotic ( 28 ) .…”

Exploring nursing and medical perceptions of sepsis management in a New Zealand emergency department: A qualitative study

“…A study in 2015, conducted prior to the introduction of the sepsis 3 definition, noted that the Australasian Triage Scale system only leads to moderate accuracy and moderate agreement between nurses regarding sepsis identification 21 . Furthermore, patients triaged to lower acuity treatment areas face a significant delay to antibiotic treatment 23 . Therefore, this may be an area to focus quality improvement and nurse education strategies.…”

“…21 Furthermore, patients triaged to lower acuity treatment areas face a significant delay to antibiotic treatment. 23 Therefore, this may be an area to focus quality improvement and nurse education strategies. A qualitative study exploring ED nurse perceptions and experience recognising sepsis in an Australian ED also highlighted the important role nurses have with regards to sepsis recognition, particularly at triage.…”