1023

Abstract

Introduction: No study has examined the differences in time to antimicrobials between patient locations at the time of severe sepsis and septic shock onset and its impact on outcomes. This study aimed to compare the time from onset of severe sepsis or septic shock to antimicrobial administration between patients in the emergency department (ED), intensive care unit (ICU), and all other hospital units. Secondary objectives were (1) to compare the rate of antimicrobial administration within one hour of disease onset between the ED, ICU, and all other hospital units, and (2) to determine the impact of location on mortality and length of stay. Methods: A retrospective chart review was conducted over a 3-year period. Adult patients identified with severe sepsis or septic shock who received antimicrobial therapy were included. Time from disease onset to administration of the first antimicrobial was calculated. Descriptive statistics and bivariate analysis were undertaken to determine the timing of antimicrobial administration. Results: A total of 386 subjects were included in the final analysis; 321 from the ED, 12 from the ICU, and 53 from all other hospital units. Patients in the ED had a median time to antimicrobial administration of 145 minutes after identification of severe sepsis or septic shock, compared with 120 minutes for the patients in the ICU and 144 minutes for patients in other hospital units (p=0.78). Patients in the ED were less likely to receive antimicrobials within one hour of onset (10%), as compared to those in the ICU (25%) and in all other hospital units (27%); p<0.05. Overall mortality was 27%. Patients in the ICU and all other hospital units had a higher rate of mortality, compared to patients in the ED (50%, 40%, and 24%, respectively; p=0.01). Patients in the ICU and all other hospital units also had longer hospital stays after sepsis onset as compared to patients in the ED (21, 22, and 15 days, respectively; p=0.03). Conclusions: There are significant delays associated with the administration of antimicrobials in patients with severe sepsis or septic shock, regardless of location at the time of disease onset. Subjects in the ED are more likely to experience delays of at least one hour as compared to those in the ICU and all other hospital units.