Study finds lower ER triage scores associated with delayed antibiotics delivery for sepsis patients

May 22, 2019

Providing early, appropriate antibiotic treatment for patients with sepsis -- a serious complication of infection that can lead to organ failure and death -- is crucial for their survival.

But in a new study, researchers at Intermountain Healthcare in Salt Lake City found that antibiotic delivery was significantly faster -- by up to 32 minutes -- for sepsis patients being treated in an emergency department if they were assigned a slightly higher score on a subjective one-to-five acuity scale commonly used for patient triage.

"Triaging patients and delivering antibiotics quickly in the emergency department is a constant challenge," said Sierra R. McLean, a University of Utah medical student and the study's lead author. "We're trying to figure out ways to provide better quality care to patients, and this study shows us we need to come up with interventions to make sure very-ill sepsis patients are appropriately recognized to help get their antibiotics on time."

In the study, Intermountain researchers examined adult sepsis patients who were treated in four Intermountain Healthcare emergency departments in Utah between July 2013 and January 2017. Many emergency departments, including those in this study, assign patients an acuity score on a five-point scale to aid triage and resource allocation, with one being most in need of immediate care and five the least.

The assessment is often made quickly, however, and the choice between mid-range triage scores can be subtle and subjective, researchers noted. For this study, investigators zeroed in on patients with mid-range scores -- those given a 2 (emergent) or 3 (urgent) - who also had abnormally low blood pressures. Among 799 eligible patients, 591 had a score of 2 and 208 had a score of 3. Researchers then evaluated how quickly they received antibiotics.

They found that patients given a triage score of 3, or urgent, had door-to-antibiotic times that were 32 minutes longer than patients assigned a triage score of 2, or emergent.

"Federal and international standards encourage the start of broad-spectrum antibiotics within three hours of a sepsis patient's arrival in the ED. Those 32 minutes can make a major difference in a patient's chances for survival," said Ithan D. Peltan, MD, MSc, senior author of the study and an attending physician in the Intermountain Medical Center Shock Trauma Intensive Care Unit and Intermountain Healthcare Telecritical Care.

"If we could find interventions to help triage patients better, we might be able to help patients get antibiotics on time," added McLean.

McLean and Dr. Peltan will present their findings from the study at ATS 2019, the annual international conference of the American Thoracic Society, in Dallas on May 22.

Dr. Peltan said the study is part of a broader look at the system level challenges that make it hard to deliver high-quality sepsis care. "How do we help these incredibly busy, skilled ED clinicians ¬- who are working in an environment where there's not much information -- to identify sepsis patients who are at risk for under-triage? This study is a step toward answering that question," he added.
-end-
The research was funded by the National Institutes of Health and the Intermountain Research and Medical Foundation. McLean joined the Intermountain research team as part of a competitive University of Utah Medical School program designed to provide students mentored experience in biomedical research.

Intermountain Healthcare is a Utah-based not-for-profit system of 24 hospitals, 160 clinics, a Medical Group with some 2,300 employed physicians and advanced care practitioners, a health insurance company called SelectHealth, and other health services. Intermountain is widely recognized as a leader in transforming healthcare through evidence-based best practices, high quality, and sustainable costs.

Intermountain Medical Center

Related Antibiotics Articles from Brightsurf:

Insights in the search for new antibiotics
A collaborative research team from the University of Oklahoma, the Memorial Sloan Kettering Cancer Center and Merck & Co. published an opinion article in the journal, Nature Chemical Biology, that addresses the gap in the discovery of new antibiotics.

New tricks for old antibiotics
The study published in the journal Immunity reveals that tetracyclines (broad spectre antibiotics), by partially inhibiting cell mitochondria activity, induce a compensatory response on the organism that decreases tissue damage caused during infection.

Benefits, risks seen with antibiotics-first for appendicitis
Antibiotics are a good choice for some patients with appendicitis but not all, according to study results published today in the New England Journal of Medicine.

How antibiotics interact
Understanding bottleneck effects in the translation of bacterial proteins can lead to a more effective combination of antibiotics / study in 'Nature Communications'

Are antivitamins the new antibiotics?
Antibiotics are among the most important discoveries of modern medicine and have saved millions of lives since the discovery of penicillin almost 100 years ago.

Hygiene reduces the need for antibiotics by up to 30%
A new paper published in the American Journal of Infection Control (AJIC), finds improved everyday hygiene practices, such as hand-washing, reduces the risk of common infections by up to 50%, reducing the need for antibiotics, by up to 30%.

Antibiotics: City dwellers and children take the most
City dwellers take more antibiotics than people in rural areas; children and the elderly use them more often than middle-aged people; the use of antibiotics decreases as education increases, but only in rich countries: These are three of the more striking trends identified by researchers of the NRW Forschungskolleg ''One Health and Urban Transformation'' at the University of Bonn.

Metals could be the link to new antibiotics
Compounds containing metals could hold the key to the next generation of antibiotics to combat the growing threat of global antibiotic resistance.

Antibiotics from the sea
The team led by Prof. Christian Jogler of Friedrich Schiller University, Jena, has succeeded in cultivating several dozen marine bacteria in the laboratory -- bacteria that had previously been paid little attention.

Antibiotics not necessary for most toothaches, according to new ADA guideline
The American Dental Association (ADA) announced today a new guideline indicating that in most cases, antibiotics are not recommended for toothaches.

Read More: Antibiotics News and Antibiotics Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.