Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2022 Feb 11;26(1):43.
doi: 10.1186/s13054-022-03899-0.

Relationship between time of emergency department admission and adherence to the Surviving Sepsis Campaign bundle in patients with septic shock

Je Sung You  1 , Yoo Seok Park  1 , Sung Phil Chung  1 , Hye Sun Lee  2 , Soyoung Jeon  2 , Won Young Kim  3 , Tae Gun Shin  4 , You Hwan Jo  5 , Gu Hyun Kang  6 , Sung Hyuk Choi  7 , Gil Joon Suh  8 , Byuk Sung Ko  9 , Kap Su Han  10 , Jong Hwan Shin  11 , Taeyoung Kong  12 ; Korean Shock Society (KoSS) Investigators
Collaborators, Affiliations
Observational Study

Relationship between time of emergency department admission and adherence to the Surviving Sepsis Campaign bundle in patients with septic shock

Je Sung You et al. Crit Care. .

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.

Keywords: Off-hour effect; Sepsis; Septic shock; Surviving Sepsis Campaign.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of patient inclusion and exclusion. KoSS Korean Shock Society, MAP mean arterial pressure
Fig. 2
Fig. 2
The patient to doctor ratio according to time zone in emergency department and the compliance rate for the complete Surviving Sepsis Campaign 3-h bundle. The bars indicate the patient to doctor ratio. The compliance rate for the complete sepsis bundle is shown by the dashed line, and the average 28-day mortality rate in the daytime and nighttime is represented by the solid line
Fig. 3
Fig. 3
Relationships between the adherence to the SSC 3-h bundle, 28-day mortality (A) and in-hospital mortality (B). The completion of SSC 3-h bundle was significantly associated with a decreased 28-day and in-hospital mortality risk among patients with septic shock. HR hazard ratio, 95% CI 95% confidence interval, SSC Surviving Sepsis Campaign
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Wang HE, Jones AR, Donnelly JP. Revised national estimates of emergency department visits for sepsis in the United States. Crit Care Med. 2017;45(9):1443–1449. doi: 10.1097/CCM.0000000000002538. - DOI - PMC - PubMed
    1. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304–377. doi: 10.1007/s00134-017-4683-6. - DOI - PubMed
    1. Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive Care Med. 2018;44(6):925–928. doi: 10.1007/s00134-018-5085-0. - DOI - PubMed
    1. Spiegel R, Farkas JD, Rola P, Kenny JE, Olusanya S, Marik PE, Weingart SD. The 2018 surviving sepsis campaign's treatment bundle: when guidelines outpace the evidence supporting their use. Ann Emerg Med. 2019;73(4):356–358. doi: 10.1016/j.annemergmed.2018.06.046. - DOI - PubMed
    1. Yang JM, Park YS, Chung SP, Chung HS, Lee HS, You JS, Lee SH, Park I. 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):884–889. doi: 10.1016/j.ajem.2014.04.049. - DOI - PubMed

Publication types