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A&E overcrowding is risk to prompt treatment for sepsis

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Overcrowded accident and emergency departments, symptomatic of the NHS, especially in winter, can lead to vital delays in patients receiving treatment for sepsis, warn US researchers.

Patients with sepsis – a life-threatening complication of an infection – had delays approaching one hour in being given antibiotics when seen in emergency departments that were overcrowded.

“Prompt initiation of appropriate antibiotics is the cornerstone of high-quality sepsis care”

Ithan Peltan

The researchers highlighted that “prompt” antibiotic initiation was linked with improved mortality in sepsis, but suggested causes of why treatment was sometimes delayed were “poorly understood”.

As a result, they investigated the potential influence of emergency department workload on “door-to-antibiotic time” for septic patients.

They looked at the records of patients admitted to an intensive care unit after being seen in the A&E departments of two hospitals and two tertiary referral centres from July 2013 to December 2015.

Emergency department workload was measured based on the ratio of registered patients to available beds.

The researchers found that, of 945 patients studied, 14% arrived when registered emergency department patients already exceeded the department’s bed number.

”I suspect similar protocols could improve timely care for sepsis”

Ithan Peltan

Patients received antibiotics within three hours in 83% of all cases in uncrowded A&Es, but 72% of the time when the department was crowded.

In addition, patients who presented at a crowded A&E rather than an empty one waited an extra 47 minutes for antibiotics and were three times less likely to start them within three hours, the initiation window cited by US guidelines.

Lead author Dr Ithan Peltan, from the University of Utah in Salt Lake City, said: “I wanted to understand how strains on hospital resources influence timely antibiotics.

“Prompt initiation of appropriate antibiotics is the cornerstone of high-quality sepsis care,” he said.

Dr Peltan highlighted that each one-hour delay in antibiotics was associated with a 7-10% increase in the odds of dying from sepsis.

“Our findings suggest adequate staff and diagnostic resources are critical to effective sepsis care,” he said. “Hospitals should also consider sepsis care reorganisation to bypass competing demands on clinicians and diagnostic resources.”

He added: “In many emergency departments, protocols coupling pre-hospital notification and a multi-disciplinary rapid response team help ensure time-dependent therapies for stroke, heart attack and trauma patients. I suspect similar protocols could improve timely care for sepsis.”

The study was presented at this year’s American Thoracic Society International Conference in Washington D.C.

Meanwhile, another US study presented at the same conference found more rapid hospital treatment of sepsis improved patient outcomes and gave support to mandatory protocols.

Quicker completion of a three-hour sepsis treatment bundle and rapid administration of antibiotics were associated with lower risk-adjusted in-hospital mortality, found researchers.

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