Emergency department sepsis screening tool decreases time to antibiotics in patients with sepsis

Published:January 23, 2018DOI:


      Recent literature has highlighted the importance of early identification and treatment of sepsis; however, limited data exists to help recognize sepsis in the emergency department (ED) through use of a screening tool. The purpose of this study was to evaluate the impact of a sepsis screening tool implemented in an academic medical center ED on compliance with the 3-hour sepsis bundle.
      This was a retrospective cohort study that included a total of 115 patients, of which 58 were in the pre-tool group and 57 were in the post-tool group. There was no difference in 3-hour bundle compliance between groups (36.2% vs. 47.4%, P = 0.26). There was no difference in the following bundle components: lactate (79.3% vs. 80.7%, P = 0.85), blood cultures (86.2% vs. 96.5%, P = 0.09), blood cultures before administering antibiotics (91.4% vs. 100%, P = 0.57) and adequate fluids administration (44.7% vs. 41.9%, P = 0.820). A significantly higher number of patients received antibiotics within 3 h in the post-tool group (58.6% vs. 89.5%, P < 0.001). Statistically significant secondary outcomes included average time to antibiotics (P = 0.04), administering antibiotics within an hour (P > 0.001), and ICU length of stay (P = 0.03). There was no difference in 30-day mortality, however mortality was numerically lower in the post-tool group (36.2% vs. 26.3%, P = 0.25).
      Although implementation of an ED sepsis screening tool did not increase 3-hour bundle compliance, it did increase the proportion of patients receiving timely antimicrobial therapy and demonstrated a trend towards decreased mortality.


      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Singer M.
        • Deutschman C.S.
        • Seymour C.W.
        • Shankar-Hari M.
        • Annane D.
        • Bauer M.
        • et al.
        The third international consensus definitions for sepsis and septic shock (Sepsis-3).
        JAMA. 2016; 315: 801-810
        • Rhodes A.
        • Evans L.E.
        • Alhazzani W.
        • Levy M.M.
        • Antonelli M.
        • Ferrer R.
        • et al.
        Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016.
        Crit Care Med. 2017; 45: 486-552
        • Wang H.E.
        • Shapiro N.I.
        • Angus D.C.
        • Yealy D.M.
        National estimates of severe sepsis in United States emergency departments.
        Crit Care Med. 2007; 35: 1928-1936
        • Yealy D.M.
        • Kellum J.A.
        • Huang D.T.
        • Barnato A.E.
        • Weissfeld L.A.
        • Pike F.
        • et al.
        A randomized trial of protocol-based care for early septic shock.
        N Engl J Med. 2014; 370: 1683-1693
        • Dellinger R.P.
        • Levy M.M.
        • Rhodes A.
        • Annane D.
        • Gerlach H.
        • Opal S.M.
        • et al.
        Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.
        Crit Care Med. 2013; 41: 580-637
        • Kumar A.
        • Roberts D.
        • Wood K.E.
        • Light B.
        • Parrillo J.E.
        • Sharma S.
        • et al.
        Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock.
        Crit Care Med. 2006; 34: 1589-1596
        • Castellanos-Ortega A.
        • Suberviola B.
        • Garcia-Astudillo L.A.
        • Holanda M.S.
        • Ortiz F.
        • Llorca J.
        • et al.
        Impact of the surviving sepsis campaign protocols on hospital length of stay and mortality in septic shock patients: results of a three-year follow-up quasi-experimental study.
        Crit Care Med. 2010; 38: 1036-1043
        • Subbe C.P.
        • Kruger M.
        • Rutherford P.
        • Gemmel L.
        Validation of a modified early warning score in medical admissions.
        QJM. 2001; 94: 521-526
        • Moore L.J.
        • Jones S.L.
        • Kreiner L.A.
        • McKinley B.
        • Sucher J.F.
        • Todd S.R.
        • et al.
        Validation of a screening tool for the early identification of sepsis.
        J Trauma. 2009; 66 ([discussion 46-7]): 1539-1546
        • Gatewood M.O.
        • Wemple M.
        • Greco S.
        • Kritek P.A.
        • Durvasula R.
        A quality improvement project to improve early sepsis care in the emergency department.
        BMJ Qual Saf. 2015; 24: 787-795
        • Ferrer R.
        • Martin-Loeches I.
        • Phillips G.
        • Osborn T.M.
        • Townsend S.
        • Dellinger R.P.
        • et al.
        Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program.
        Crit Care Med. 2014; 42: 1749-1755
        • Zhang D.
        • Micek S.T.
        • Kollef M.H.
        Time to appropriate antibiotic therapy is an independent determinant of postinfection ICU and hospital lengths of stay in patients with sepsis.
        Crit Care Med. 2015; 43: 2133-2140
        • Bagshaw S.M.
        • Lapinsky S.
        • Dial S.
        • Arabi Y.
        • Dodek P.
        • Wood G.
        • et al.
        Acute kidney injury in septic shock: clinical outcomes and impact of duration of hypotension prior to initiation of antimicrobial therapy.
        Intensive Care Med. 2009; 35: 871-881
        • Iscimen R.
        • Cartin-Ceba R.
        • Yilmaz M.
        • Khan H.
        • Hubmayr R.D.
        • Afessa B.
        • et al.
        Risk factors for the development of acute lung injury in patients with septic shock: an observational cohort study.
        Crit Care Med. 2008; 36: 1518-1522
        • Garnacho-Montero J.
        • Aldabo-Pallas T.
        • Garnacho-Montero C.
        • Cayuela A.
        • Jimenez R.
        • Barroso S.
        • et al.
        Timing of adequate antibiotic therapy is a greater determinant of outcome than are TNF and IL-10 polymorphisms in patients with sepsis.
        Crit Care. 2006; 10: R111
        • Mouncey P.R.
        • Osborn T.M.
        • Power G.S.
        • Harrison D.A.
        • Sadique M.Z.
        • Grieve R.D.
        • et al.
        Trial of early, goal-directed resuscitation for septic shock.
        N Engl J Med. 2015; 372: 1301-1311
        • Peake S.L.
        • Delaney A.
        • Bailey M.
        • Bellomo R.
        • Cameron P.A.
        • Cooper D.J.
        • et al.
        Goal-directed resuscitation for patients with early septic shock.
        N Engl J Med. 2014; 371: 1496-1506