Emergency Medicine Mon 02 August 2021 Ensuring blood cultures and reducing the timing of first dose of antibiotic administration in sepsis patients: a quality improvement study in department of emergency medicine aiims new delhi
Researcher : Charu malhotra
Research Guide : Akshay kumar
Institution Name : All india institute of medical sciences new delhi


Background: Sepsis is a well-known time sensitive medical emergency, yet it remains a challenge in a busy emergency department to identify patients with suspected sepsis early.This leads to significant delays in antibiotic administration which adversely affects the outcomes. for these patients. Secondly, drawing of blood samples for cultures prior to antibiotic administration is essential to identify pathogens and improve outcomes in sepsis patients. (1). The primary objective of our Quality Improvement (QI) project was to reduce the door-to-antibiotic time (DTAT) by from the baseline in patients with suspected sepsis and to improve the blood culture collection rate from baseline. Methods: This QI project was conducted in the ED of a tertiary care teaching hospital of North India; the ED receives approximately 400 patients per day. Adult patients with suspected sepsis presenting to our ED were included in the study, between January 2019 and December 2020. The study was divided into three phases; baseline phase (120 patients), intervention phase (120 patients) and post-intervention phase (120 patients).Door to antibiotic time and blood cultures prior to antibiotic administration was recorded for all patients. Blood culture yield and 24-hourr in-hospital mortality were also recorded using standard data templates. Change ideas planned by the Sepsis Quality Improvement Team were implemented after conducting plan-do-study-actcycles (PDSA) cycles. Results: The median DTAT (IQR) in pre-intervention phase was 155.5 minutes (92.5 – 323), which decreased to 115.5 minutes (71.5 – 215) in the intervention phase. This DTAT further reduced to 76.5 minutes (51.5 – 116) in the post-intervention phase. Drawing of blood cultures prior to antibiotic administration improved by 55.8%. Application of novel screening tool at triage was found to be an independent predictor of reduced door-to-antibiotic time. The QI initiative improved the care of patients with sepsis in the ED. Conclusion: Streamlining sepsis care is essential in the Emergency Department. Application of novel sepsis screening tool were independent predictors of reduced door-to-antibiotic time.Short onsite training sessions were crucial in spreading awareness and engaging with frontline staff. This quality improvement initiative, one of the first projects conducted in a LMIC can be reciprocated in similar settings for patients with suspected sepsis.

DOI: 1627902453   Year of publication: 2021

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