ED crowding linked to delayed antibiotics for sepsis, study finds

Overcrowding in the emergency department could be a barrier to the early administration of antibiotics for sepsis, according to a study published in Annals of Emergency Medicine.

For the study, researchers analyzed data on 3,572 sepsis patients who visited EDs at two community hospitals, a regional referral hospital and a tertiary teaching hospital.

Researchers defined ED occupancy rate as the ratio of registered patients to licensed beds. They considered ED overcrowding as an ED occupancy rate of greater than or equal to 1.

Of the 3,572 patients, 70 percent arrived when the ED occupancy rate was greater than or equal to 0.5, and 14 percent of patients came to an overcrowded ED. The median door-to-antibiotic time was 158 minutes. During overcrowding, 46 percent of patients received antibiotics within three hours of arriving at the ED, compared to 63 percent of patients when there was no overcrowding.

A 10 percent increase in ED occupancy rate was associated with a four-minute increase in door-to-antibiotic time and a decrease in the odds of a sepsis patient starting antibiotics within three hours, researchers found.

"ED crowding was associated with increased sepsis antibiotic delay," they concluded. "Hospitals must devise strategies to optimize sepsis antibiotic administration during periods of ED crowding."

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