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Observational Study
. 2024 Apr 12;24(1):58.
doi: 10.1186/s12873-024-00973-4.

An observational study on the impact of overcrowding towards door-to-antibiotic time among sepsis patients presented to emergency department of a tertiary academic hospital

Evelyn Yi Wen Chau  1 , Afliza Abu Bakar  2 , Aireen Binti Zamhot  3 , Ida Zarina Zaini  3 , Siti Norafida Binti Adanan  4 , Dazlin Masdiana Binti Sabardin  3
Affiliations
Observational Study

An observational study on the impact of overcrowding towards door-to-antibiotic time among sepsis patients presented to emergency department of a tertiary academic hospital

Evelyn Yi Wen Chau et al. BMC Emerg Med. .

Abstract

Background: The latest Surviving Sepsis Campaign 2021 recommends early antibiotics administration. However, Emergency Department (ED) overcrowding can delay sepsis management. This study aimed to determine the effect of ED overcrowding towards the management and outcome of sepsis patients presented to ED.

Methods: This was an observational study conducted among sepsis patients presented to ED of a tertiary university hospital from 18th January 2021 until 28th February 2021. ED overcrowding status was determined using the National Emergency Department Overcrowding Score (NEDOCS) scoring system. Sepsis patients were identified using Sequential Organ Failure Assessment (SOFA) scores and their door-to-antibiotic time (DTA) were recorded. Patient outcomes were hospital length of stay (LOS) and in-hospital mortality. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 26. P-value of less than 0.05 for a two-sided test was considered statistically significant.

Results: Total of 170 patients were recruited. Among them, 33 patients presented with septic shock and only 15% (n = 5) received antibiotics within one hour. Of 137 sepsis patients without shock, 58.4% (n = 80) received antibiotics within three hours. We found no significant association between ED overcrowding with DTA time (p = 0.989) and LOS (p = 0.403). However, in-hospital mortality increased two times during overcrowded ED (95% CI 1-4; p = 0.041).

Conclusion: ED overcrowding has no significant impact on DTA and LOS which are crucial indicators of sepsis care quality but it increases overall mortality outcome. Further research is needed to explore other factors such as lack of resources, delay in initiating fluid resuscitation or vasopressor so as to improve sepsis patient care during ED overcrowding.

Keywords: Door-to-antibiotic time; ED overcrowding; In-hospital mortality; Length of hospital stay; Sepsis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow-diagram of sample selection
Fig. 2
Fig. 2
DTA time according to NEDOCS category White dots: outliers
Fig. 3
Fig. 3
Patient outcome according to DTA time
Fig. 4
Fig. 4
Comparing sepsis groups and their outcomes according to DTA time
See this image and copyright information in PMC

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