Relationship Between Time of Emergency Department Admission and Adherence to the Surviving Sepsis Campaign Bundle in Patients with Septic Shock

Overview

Journal Crit Care

Specialty Critical Care

Date 2022 Feb 12

PMID 35148797

Authors

Je Sung You

Yoo Seok Park

Sung Phil Chung

Hye Sun Lee

Soyoung Jeon

Won Young Kim

Tae Gun Shin

You Hwan Jo

Gu Hyun Kang

Sung Hyuk Choi

Gil Joon Suh

Byuk Sung Ko

Kap Su Han

Jong Hwan Shin

Taeyoung Kong

Affiliations

Soon will be listed here.

Abstract

Background: Nighttime hospital admission is often associated with increased mortality risk in various diseases. This study investigated compliance rates with the Surviving Sepsis Campaign (SSC) 3-h bundle for daytime and nighttime emergency department (ED) admissions and the clinical impact of compliance on mortality in patients with septic shock.

Methods: We conducted an observational study using data from a prospective, multicenter registry for septic shock provided by the Korean Shock Society from 11 institutions from November 2015 to December 2017. The outcome was the compliance rate with the SSC 3-h bundle according to the time of arrival in the ED.

Results: A total of 2049 patients were enrolled. Compared with daytime admission, nighttime admission was associated with higher compliance with the administration of antibiotics within 3 h (adjusted odds ratio (adjOR), 1.326; 95% confidence interval (95% CI), 1.088-1.617, p = 0.005) and with the complete SSC bundle (adjOR, 1.368; 95% CI, 1.115-1.678; p = 0.003), likely to result from the increased volume of all patients and sepsis patients admitted during daytime hours. The hazard ratios of the completion of SSC bundle for 28-day mortality and in-hospital mortality were 0.750 (95% CI 0.590-0.952, p = 0.018) and 0.714 (95% CI 0.564-0.904, p = 0.005), respectively.

Conclusion: Septic shock patients admitted to the ED during the daytime exhibited lower sepsis bundle compliance than those admitted at night. Both the higher number of admitted patients and the higher patients to medical staff ratio during daytime may be factors that are responsible for lowering the compliance.

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References

Sundararajan K, Flabouris A, Thompson C . Diurnal variation in the performance of rapid response systems: the role of critical care services-a review article. J Intensive Care. 2016; 4:15. PMC: 4765019. DOI: 10.1186/s40560-016-0136-5. View

Peltan I, Bledsoe J, Oniki T, Sorensen J, Jephson A, Allen T . Emergency Department Crowding Is Associated With Delayed Antibiotics for Sepsis. Ann Emerg Med. 2018; 73(4):345-355. DOI: 10.1016/j.annemergmed.2018.10.007. View

Bell C, Redelmeier D . Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med. 2001; 345(9):663-8. DOI: 10.1056/NEJMsa003376. View

Wang H, Jones A, Donnelly J . Revised National Estimates of Emergency Department Visits for Sepsis in the United States. Crit Care Med. 2017; 45(9):1443-1449. PMC: 5609499. DOI: 10.1097/CCM.0000000000002538. View

Shin T, Jo I, Choi D, Kang M, Jeon K, Suh G . The adverse effect of emergency department crowding on compliance with the resuscitation bundle in the management of severe sepsis and septic shock. Crit Care. 2013; 17(5):R224. PMC: 4055965. DOI: 10.1186/cc13047. View

Rowe B, McRae A, Rosychuk R . Temporal trends in emergency department volumes and crowding metrics in a western Canadian province: a population-based, administrative data study. BMC Health Serv Res. 2020; 20(1):356. PMC: 7183635. DOI: 10.1186/s12913-020-05196-4. View

Ryoo S, Kang G, Shin T, Hwang S, Kim K, Jo Y . Clinical outcome comparison of patients with septic shock defined by the new sepsis-3 criteria and by previous criteria. J Thorac Dis. 2018; 10(2):845-853. PMC: 5864585. DOI: 10.21037/jtd.2018.01.96. View

Whitfield P, Ratliff P, Lockhart L, Andrews D, Komyathy K, Sloan M . Implementation of an adult code sepsis protocol and its impact on SEP-1 core measure perfect score attainment in the ED. Am J Emerg Med. 2019; 38(5):879-882. DOI: 10.1016/j.ajem.2019.07.002. View

Ranzani O, Monteiro M, Besen B, Azevedo L . Association of Sepsis Diagnosis at Daytime and on Weekdays with Compliance with the 3-Hour Sepsis Treatment Bundles. A Multicenter Cohort Study. Ann Am Thorac Soc. 2020; 17(8):980-987. DOI: 10.1513/AnnalsATS.201910-781OC. View

10.

Matsumura Y, Nakada T, Abe T, Ogura H, Shiraishi A, Kushimoto S . Nighttime and non-business days are not associated with increased risk of in-hospital mortality in patients with severe sepsis in intensive care units in Japan: The JAAM FORECAST study. J Crit Care. 2019; 52:97-102. DOI: 10.1016/j.jcrc.2019.04.021. View

11.

Raghavan M, Marik P . Management of sepsis during the early "golden hours". J Emerg Med. 2006; 31(2):185-99. DOI: 10.1016/j.jemermed.2006.05.008. View

12.

Yang J, Park Y, Chung S, Chung H, Lee H, You J . Implementation of a clinical pathway based on a computerized physician order entry system for ischemic stroke attenuates off-hour and weekend effects in the ED. Am J Emerg Med. 2014; 32(8):884-9. DOI: 10.1016/j.ajem.2014.04.049. View

13.

Ryu J, Min M, Lee D, Yeom S, Lee S, Wang I . Changes in Relative Importance of the 5-Level Triage System, Korean Triage and Acuity Scale, for the Disposition of Emergency Patients Induced by Forced Reduction in Its Level Number: a Multi-Center Registry-based Retrospective Cohort Study. J Korean Med Sci. 2019; 34(14):e114. PMC: 6460112. DOI: 10.3346/jkms.2019.34.e114. View

14.

Spiegel R, Farkas J, Rola P, Kenny J, Olusanya S, Marik P . The 2018 Surviving Sepsis Campaign's Treatment Bundle: When Guidelines Outpace the Evidence Supporting Their Use. Ann Emerg Med. 2018; 73(4):356-358. DOI: 10.1016/j.annemergmed.2018.06.046. View

15.

Cram P, Hillis S, Barnett M, Rosenthal G . Effects of weekend admission and hospital teaching status on in-hospital mortality. Am J Med. 2004; 117(3):151-7. DOI: 10.1016/j.amjmed.2004.02.035. View

16.

Ryoo S, Han K, Ahn S, Shin T, Hwang S, Chung S . The usefulness of C-reactive protein and procalcitonin to predict prognosis in septic shock patients: A multicenter prospective registry-based observational study. Sci Rep. 2019; 9(1):6579. PMC: 6488613. DOI: 10.1038/s41598-019-42972-7. View

17.

Hayden G, Tuuri R, Scott R, Losek J, Blackshaw A, Schoenling A . Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED. Am J Emerg Med. 2015; 34(1):1-9. PMC: 4905767. DOI: 10.1016/j.ajem.2015.08.039. View

18.

Almeida M, Ribeiro O, Aragao I, Costa-Pereira A, Cardoso T . Differences in compliance with Surviving Sepsis Campaign recommendations according to hospital entrance time: day versus night. Crit Care. 2013; 17(2):R79. PMC: 4056434. DOI: 10.1186/cc12689. View

19.

Zhou Y, Li W, Herath C, Xia J, Hu B, Song F . Off-Hour Admission and Mortality Risk for 28 Specific Diseases: A Systematic Review and Meta-Analysis of 251 Cohorts. J Am Heart Assoc. 2016; 5(3):e003102. PMC: 4943279. DOI: 10.1161/JAHA.115.003102. View

20.

Seymour C, Gesten F, Prescott H, Friedrich M, Iwashyna T, Phillips G . Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. N Engl J Med. 2017; 376(23):2235-2244. PMC: 5538258. DOI: 10.1056/NEJMoa1703058. View