Crowding in the emergency department (ED) was associated with the timely administration of antibiotics for patients presenting with sepsis, according to a study published in the Annals of Emergency Medicine.

Sepsis is fatal for 15% to 20% of hospitalized patients, and studies have suggested that the timely administration of antibiotic therapy is a key determinant of sepsis mortality and morbidity. Although international guidelines presently recommend that antibiotics be initiated within 1 hour of arrival at the ED, this goal is not achieved for most patients. In this study, the researchers investigated the association of ED crowding with antibiotic delay among patients who presented with sepsis. They conducted a retrospective cohort study using data from 2 community hospitals: a regional referral hospital, and a tertiary teaching hospital. ED overcrowding was defined as an ED occupancy rate ≥1.

Of a total of 3572 patients with sepsis, 70% arrived when the ED occupancy rate was greater than or equal to 0.5, whereas 14% presented to an overcrowded ED. The median “door-to-antibiotic time” was 158 minutes (interquartile range, 109-216 minutes). Only 46% of patients had antibiotic therapy initiated within 3 hours of ED arrival vs 63% when it was not (difference, 14.4%; 95% CI, 9.7%-19.2%). Each 10% increase in the ED occupancy rate was associated with a 4.0-minute increase (95% CI, 2.8-5.2 minutes) in the time to “door-to-antibiotic,” as well as a decrease in the odds that antibiotic therapy would be started within 3 hours (odds ratio, 0.90; 95% CI 0.88-0.93).

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“Our findings also help illuminate when and how crowding may influence antibiotic initiation,” the researchers concluded.


Peltan ID, Bledsoe JR, Oniki TA, et al. Emergency department crowding is associated with delayed antibiotics for sepsis [published online November 20, 2018]. Ann Emerg Med. doi: 10.1016/j.annemergmed.2018.10.007