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

Hitti, Eveline; Lewin, John J.; López, José María Rodríguez; Hansen, Johan; Pipkin, Michael; Itani, Taha; Gurny, Paul

doi:10.1016/j.jemermed.2011.05.015

Cited by 34 publications

(21 citation statements)

References 14 publications

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“…We did find that patients who were seen on off-hours were more likely to have an HRURV. This is in line with multiple other studies that have found a drop in quality metrics on off-hours including door-to-balloon time19 and door to antibiotic inpatients with sepsis 20. This could be related to differences in staffing, turnaround time of images or consultations in the ED on off-hours, although these were not explored in our study.…”

Section: Discussionsupporting

confidence: 86%

Characteristics and determinants of high-risk unscheduled return visits to the emergency department

et al. 2019

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BackgroundHigh-risk unscheduled return visits (HRURVs), defined as return visits within 72 hours that require admission or die in the emergency department (ED) on representation, are a key quality metric in the ED. The objective of this study was to determine the incidence and describe the characteristics and predictors of HRURVs to the ED.MethodsCase–control study, conducted between 1 November 2014 and 31 October 2015. Cases included all HRURVs over the age of 18 that presented to the ED. Controls were selected from patients who were discharged from the ED during the study period and did not return in the next 72 hours. Controls were matched to cases based on gender, age (±5 years) and date of presentation.ResultsOut of 38 886 ED visits during the study period, 271 are HRURVs, giving an incidence of HRURV of 0.70% (95% CI 0.62% to 0.78%). Our final analysis includes 270 HRURV cases and 270 controls, with an in-ED mortality rate of 0.7%, intensive care unit admission of 11.1% and need for surgical intervention of 22.2%. After adjusting for other factors, HRURV cases are more likely to be discharged with a diagnosis related to digestive system or infectious disease (OR 1.64, 95% CI 1.02 to 2.65 and OR 2.81, 95% CI 1.05 to 7.51, respectively). Furthermore, presentation to the ED during off-hours is a significant predictor of HRURV (OR 1.64, 95% CI 1.11 to 2.43) as is the presence of a handover during the patient visit (OR 1.68, 95% CI 1.02 to 2.75).ConclusionHRURV is an important key quality outcome metric that reflects a subgroup of ED patients with specific characteristics and predictors. Efforts to reduce this HRURV rate should focus on interventions targeting patients discharged with digestive system, kidney and urinary tract and infectious diseases diagnosis as well as exploring the role of handover tools in reducing HRURVs.

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Section: Discussionsupporting

confidence: 86%

Characteristics and determinants of high-risk unscheduled return visits to the emergency department

et al. 2019

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“…Antibiotics for infection is one recommended process indicator of maternal care [15]. Infection prevention and treatment are important to prevent mothers with life threatening conditions from developing sepsis and undergoing longer hospitalization [40]. No significant difference in antibiotic administration as treatment or prophylaxis on the outcome of pregnancies with life threatening conditions was demonstrated in this research, but the near miss group had a higher percentage of antibiotic administration than the maternal death group.…”

Section: Discussionmentioning

confidence: 71%

Maternal care quality in near miss and maternal mortality in an academic public tertiary hospital in Yogyakarta, Indonesia: a retrospective cohort study

Mawarti

Hakimi

2017

BMC Pregnancy Childbirth

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BackgroundReducing maternal mortality remains a major challenge for health care systems worldwide. The factors related to maternal mortality were extensively researched, and maternal death clusters around labour, delivery and the immediate postpartum period. Studies on the quality of maternal care in academic medical centre settings in low income countries are uncommon.MethodsA retrospective cohort study of maternal deaths was conducted in an academic public tertiary hospital in Yogyakarta, and maternal near misses were used as controls. Data were obtained from medical records from February 1, 2011 to September 30, 2012. Three groups of variables were measured: (1) timeliness of care, (2) adherence to a standard of process indicators, and (3) associated extraneous variables. Variables were analysed using logistic regression to explore their effects on maternal mortality.ResultsThe mean of triage response time and obstetric resident response time were longer in maternal deaths (8 ± 3.59 and 36.17 ± 23.48 min respectively) compared to near misses (1.29 ± 0.24 and 18.78 ± 4.85 min respectively). Near misses more frequently received oxytocin treatment than the maternal deaths (OR 0.13; 95%CI 0.02–0.77). Magnesium sulfate treatment in severe-preeclampsia or eclampsia was less given in maternal deaths although insignificant statistically (OR 0.19; 95% CI 0.03–1.47). Prophylactic antibiotic was also more frequently given in near misses than in maternal deaths though insignificant statistically (OR 0.3; 95% CI 0.06–1.56). Extraneous variables, such as caesarean sections were less performed in maternal deaths (OR 0.15; 95% CI 0.04–0.51), vaginal deliveries were more frequent in maternal deaths (OR 3.47; 95% CI 1.05–11.54), and more women in near misses were referred from other health care facilities (OR 0.09; 95% CI 0.01–0.91).ConclusionsThe near misses had relatively received better quality of care compared to the maternal deaths. The near misses had received faster response time and better treatments. Timely referral systems enabled benefits to prevent maternal death.

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“…Most of the previous studies investigating the timing of antimicrobials and the compliance with the SSC sepsis bundles reported only ICU mortality rates, focused mainly on patients treated in the emergency department or in the ICU, and did not evaluate the impact of delayed source control on patient outcome [3,5,17,19,20]. However, many of these patients may be admitted also from general wards or the operating room and may require effective surgical and other measures of source control.…”

Section: Introductionmentioning

confidence: 99%

Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study

et al. 2014

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IntroductionCurrent sepsis guidelines recommend antimicrobial treatment (AT) within one hour after onset of sepsis-related organ dysfunction (OD) and surgical source control within 12 hours. The objective of this study was to explore the association between initial infection management according to sepsis treatment recommendations and patient outcome.MethodsIn a prospective observational multi-center cohort study in 44 German ICUs, we studied 1,011 patients with severe sepsis or septic shock regarding times to AT, source control, and adequacy of AT. Primary outcome was 28-day mortality.ResultsMedian time to AT was 2.1 (IQR 0.8 – 6.0) hours and 3 hours (-0.1 – 13.7) to surgical source control. Only 370 (36.6%) patients received AT within one hour after OD in compliance with recommendation. Among 422 patients receiving surgical or interventional source control, those who received source control later than 6 hours after onset of OD had a significantly higher 28-day mortality than patients with earlier source control (42.9% versus 26.7%, P <0.001). Time to AT was significantly longer in ICU and hospital non-survivors; no linear relationship was found between time to AT and 28-day mortality. Regardless of timing, 28-day mortality rate was lower in patients with adequate than non-adequate AT (30.3% versus 40.9%, P < 0.001).ConclusionsA delay in source control beyond 6 hours may have a major impact on patient mortality. Adequate AT is associated with improved patient outcome but compliance with guideline recommendation requires improvement. There was only indirect evidence about the impact of timing of AT on sepsis mortality.

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

Cited by 34 publications

References 14 publications

Characteristics and determinants of high-risk unscheduled return visits to the emergency department

Characteristics and determinants of high-risk unscheduled return visits to the emergency department

Maternal care quality in near miss and maternal mortality in an academic public tertiary hospital in Yogyakarta, Indonesia: a retrospective cohort study

Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study

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