Relationship between time of emergency department admission and adherence to the Surviving Sepsis Campaign bundle in patients with septic shock

Abstract

Background Nighttime hospital admission is often associated with increased mortality risk in various diseases. This study investigated compliance rates with the Surviving Sepsis Campaign (SSC) 3-h bundle for daytime and nighttime emergency department (ED) admissions and the clinical impact of compliance on mortality in patients with septic shock. Methods We conducted an observational study using data from a prospective, multicenter registry for septic shock provided by the Korean Shock Society from 11 institutions from November 2015 to December 2017. The outcome was the compliance rate with the SSC 3-h bundle according to the time of arrival in the ED. Results A total of 2049 patients were enrolled. Compared with daytime admission, nighttime admission was associated with higher compliance with the administration of antibiotics within 3 h (adjusted odds ratio (adjOR), 1.326; 95% confidence interval (95% CI), 1.088–1.617, p = 0.005) and with the complete SSC bundle (adjOR, 1.368; 95% CI, 1.115–1.678; p = 0.003), likely to result from the increased volume of all patients and sepsis patients admitted during daytime hours. The hazard ratios of the completion of SSC bundle for 28-day mortality and in-hospital mortality were 0.750 (95% CI 0.590–0.952, p = 0.018) and 0.714 (95% CI 0.564–0.904, p = 0.005), respectively. Conclusion Septic shock patients admitted to the ED during the daytime exhibited lower sepsis bundle compliance than those admitted at night. Both the higher number of admitted patients and the higher patients to medical staff ratio during daytime may be factors that are responsible for lowering the compliance.

Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in Korea

“…In our study, prolonged EDLOS was significantly associated with night-time presentations, suggesting decreased access to specialist consultations and diagnostic or treatment modalities compared to regular working hours [ 29 , 54 ]. Patients assigned to the lower acuity scores in the initial triage were more likely to have prolonged EDLOS than those assigned to higher acuity scores.…”

Saved by the Bell—Automated Paging Alerts to Improve Sepsis Bundle Compliance*

“…Over 70% of study patients, even with automated paging reminders to their treatment teams, did not receive timely sepsis bundles. The inability for the intervention to affect consensus behavior change from treatment teams could reflect several possibilities: 1) Wrong patients—study patients were not truly septic as judged by the bedside clinician’s assessment, 2) Wrong metrics—the sepsis bundle would not benefit the study patients as judged by the bedside clinician’s assessment, and 3) Logistics—processes of care are complicated in the emergency department, and getting timely care is difficult even for the right patients and the right metrics (4).…”

Red cell distribution width and in‐hospital mortality in septic shock: A public database research

“…2 Current researches reported that the in-hospital mortality in sepsis varied from over 20% to nearly 40%. [3][4][5] Hence, early recognition of septic shock patients at high risk of poor prognosis plays an instrumental role in the clinical practice and course.…”

“…It has been a public health issue worldwide with high incidence of impaired quality of life for several decades 2 . Current researches reported that the in‐hospital mortality in sepsis varied from over 20% to nearly 40% 3–5 . Hence, early recognition of septic shock patients at high risk of poor prognosis plays an instrumental role in the clinical practice and course.…”