IMPROVING DOOR-TO-ANTIBIOTIC TIME IN SEVERELY SEPTIC EMERGENCY DEPARTMENT PATIENTS

被引:33
作者
Hitti, Eveline A. [1 ]
Lewin, John J., III [2 ,3 ]
Lopez, Jose [4 ]
Hansen, Jonathan [4 ]
Pipkin, Michael [4 ]
Itani, Taha
Gurny, Paul [5 ,6 ]
机构
[1] Amer Univ Beirut, Med Ctr, Dept Emergency Med, Beirut, Lebanon
[2] Johns Hopkins Med Inst, Dept Pharm, Baltimore, MD 21205 USA
[3] Johns Hopkins Med Inst, Dept Anesthesiol & Crit Care Med, Baltimore, MD 21205 USA
[4] Franklin Sq Hosp Ctr, Dept Emergency Med, Baltimore, MD USA
[5] Johns Hopkins Univ, Carey Sch Business, Baltimore, MD USA
[6] Johns Hopkins Univ, Sch Med, Baltimore, MD USA
关键词
sepsis; emergency department; antibiotics; timing; automated dispensing cabinet; SEVERE SEPSIS; PRACTICE GUIDELINES; UNITED-STATES; MANAGEMENT; COSTS; SHOCK;
D O I
10.1016/j.jemermed.2011.05.015
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: The Surviving Sepsis Campaign (SSC) guidelines recommend that broad-spectrum antibiotics be administered to severely septic patients within 3 h of emergency department (ED) admission. Despite the well-established evidence regarding the benefit of timely antibiotics, adoption of the SSC recommendation into daily clinical practice has been slow and sporadic. Study Objective: To study the impact of storing broad-spectrum antibiotics in an ED automated dispensing cabinet (ADC) on the timeliness of antibiotic administration in severely septic patients presenting to the ED. Methods: Retrospective observational study of timeliness of antibiotic administration in severely septic patients presenting to a community ED before and after adding broad-spectrum antibiotics to the ED ADC. Data on 56 patients before and 54 patients after the intervention were analyzed. The primary outcome measure was mean order-to-antibiotic time. Secondary outcome measures included mean door-to-antibiotic time and percentage of patients receiving antibiotics within 3 h. Results: The final analysis was on 110 patients. Order-to-antibiotic administration time was reduced by 29 min post-intervention (55 min vs. 26 min, 95% confidence interval [CI] 12.5 45.19). Mean door-to-antibiotic time was also reduced by 70 min (167 min vs. 97 min, 95% CI 37.53 102.29). The percentage of severely septic patients receiving antibiotics within 3 h of arrival to the ED increased from 65% pre-intervention to 93% post-intervention (95% CI 0.12 0.42). Conclusion: Storing key antibiotics in an institution's severe sepsis antibiogram in the ED ADC can significantly reduce order-to-antibiotic times and increase the percentage of patients receiving antibiotics within the recommended 3 h of ED arrival. (C) 2012 Elsevier Inc.
引用
收藏
页码:462 / 468
页数:7
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