|Topic:||30. Sepsis / Adult / Health Services Research/Quality Improvement / Critical Care (CC)|
|Authors:||R.Y.H. Kim, A. Ng, Y. Kothari, J.D. Price, A. Persaud, T. Wiemken, S. Furmanek, M. Saad, R. Cavallazzi; Louisville, KY/US|
Sepsis is common and is a leading cause of mortality. We evaluated the impact of time spent in the ED and process of care on mortality in patients with severe sepsis/septic shock.
This is a retrospective cohort study that included 117 patients admitted from the ED to the ICU at the University of Louisville Hospital. Inclusion criteria were ICD codes for severe sepsis/septic shock and a lactate > 4 mmol/L. The primary outcome was in-hospital mortality. We evaluated the crude and adjusted association between mortality and the following: time from triage to antibiotic ordered and time from triage to antibiotic given. For adjustment, we used the expected mortality as calculated according to the 2015 University Health Consortium for Disease Severity Risk Assessment. We also evaluated the difference in time spent in the ED in survivors vs non-survivors.
After adjusting for expected mortality, every hour increase from triage to antibiotic ordered was associated with a 22% increase in mortality (RR = 1.22; 95% CI: 1.069 to 1.402; P = 0.004), and every hour increase from triage to antibiotic given was associated with a 15% increase in mortality (RR = 1.15; 95% CI: 1.025 to 1.298; P = 0.017). There was no significant difference in time spent in the ED between survivors and non-survivors (5.5 vs 5.7 hours; P = 0.804).
While there was no significant difference in time spent in the ED between survivors and non-survivors, the process of care showed important associations with mortality. In particular, a delay in both triage to antibiotic order and triage to antibiotic administration were associated with increased mortality in patients with severe sepsis/septic shock. Our study emphasizes the importance of early recognition of septic patients and the early implementation of antibiotics along with other resuscitative measures. We also identify the opportunity for quality improvement initiatives to enhance recognition of septic patients and optimize their process of care.