LAUSR

www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: Robust evidence links timely administration of antibiotics to good outcomes in patients with sepsis. Current guidelines recommend an ambitious goal of antibiotic administration within 1 hour from “time zero”. Little is known about the timing of key processes from Emergency Department (ED) arrival to antibiotic administration for patients with sepsis. Methods: We studied patients presenting to the ED with sepsis (defined as suspected infection and organ dysfunction) at two hospitals with mature sepsis treatment pathways including order sets with preselected antibiotic regimens. We conceptualized the total time from ED arrival to antibiotic administration into 3 intervals. Interval 1: time from arrival to the time a physician opens the patient’s medical record (door to doctor time), Interval 2: time from chart open to entering the antibiotic order (doctor to decision time) and Interval 3: time from order entry to administration of the antibiotic (decision to drug time). We retrospectively abstracted these times from medical records. Because we were specifically interested in how antibiotic allergies might affect delays, we recorded whether patients had allergy to any of the preselected antibiotics. Results: Of 155 patients presenting to the ED with sepsis, 18.7% (28) died during hospitalization. Overall, a mean time of 119.08 minutes (SD 88.8) elapsed between ED arrival and antibiotic administration. The mean time between ED arrival and chart opening by a physician was 16.9 minutes (SD 29.8), the mean time required for physicians to enter an antibiotic order was 68.2 minutes (SD 60.5), followed by another mean time of 40.2 minutes (SD 38.2) to begin drug infusion. Patients with allergy to the preselected antibiotics experienced a longer delay from antibiotic order to administration (36.3 vs 50.1 min, p = 0.09) and longer total delay from chart open to administration (101.6 vs 125.2 min, p = 0.16), but similar time from chart open to placement of antibiotic order (65.3 vs 75.7 min, p = 0.43). Conclusions: In order to reduce ED delays in antibiotic administration for patients with sepsis, we examined the critical phases between arrival and treatment. We report average times for 3 intervals, showing that the time from physician chart open to antibiotic order (doctor to decision time) represents the longest interval of delay. Although not statistically significant, allergy to order set antibiotics was associated with longer time from order to administration (decision to drug time).