Emergency Department Sepsis Protocol does not Impact Time to Antibiotics

ABSTRACT

Background: Early goal directed therapy (EGDT) can reduce mortality in an Intensive Care Unit (ICU) population with severe sepsis. It is not clear whether EGDT can be effectively implemented in an Emergency Department (ED) with existing resources to achieve the same goals. Objectives: To assess the impact of EGDT in our ED with existing resources on time to antibiotics (ABX) and patient outcomes. Methods: We performed a before and after study of the effects of the EGDT protocol on patients over age 21 with severe sepsis admitted to the ICU. Time to ABX was the primary outcome, mortality and other care processes were secondary. Descriptive statistics, Fisher's exact chi-square, and Wilcoxon rank sum tests compared time periods. Multivariate analyses with logistic and Cox proportional hazard regression models were performed. Results: 192 cases: 91 before and 101 after protocol. Groups were similar in demographics, co-morbidities, severity scores, and overall mortality of 17.7%. Patients with higher Mortality in ED scores (MEDS) received ABX sooner than patients with lower MEDS after adjusting for time period. There was no difference in time to ABX between time periods after adjusting for disease severity (Hazard Ratio: 0.88, 95% CI: 0.65-1.18; OR: 0.88, 95% CI: 0.49-1.57). Conclusion: Our EGDT protocol did not change management, time to ABX, or mortality of septic patients admitted to the ICU, when relying on existing resources. Further study is needed to evaluate barriers to EGDT and feasibility of translating resource intensive protocols to the bedside in routine ED care.