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Improving door-to-antibiotic time in severely septic emergency department patients

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dc.contributor.author Hitti E.A.
dc.contributor.author Lewin III J.J.
dc.contributor.author Lopez J.
dc.contributor.author Hansen J.
dc.contributor.author Pipkin M.
dc.contributor.author Itani T.
dc.contributor.author Gurny P.
dc.contributor.editor
dc.date Apr-2012
dc.date.accessioned 2017-10-05T15:34:24Z
dc.date.available 2017-10-05T15:34:24Z
dc.date.issued 2012
dc.identifier 10.1016/j.jemermed.2011.05.015
dc.identifier.isbn
dc.identifier.issn 07364679
dc.identifier.uri http://hdl.handle.net/10938/15486
dc.description.abstract Background: The Surviving Sepsis Campaign (SSC) guidelines recommend that broad-spectrum antibiotics be administered to severely septic patients within 3 h of emergency department (ED) admission. Despite the well-established evidence regarding the benefit of timely antibiotics, adoption of the SSC recommendation into daily clinical practice has been slow and sporadic. Study Objective: To study the impact of storing broad-spectrum antibiotics in an ED automated dispensing cabinet (ADC) on the timeliness of antibiotic administration in severely septic patients presenting to the ED. Methods: Retrospective observational study of timeliness of antibiotic administration in severely septic patients presenting to a community ED before and after adding broad-spectrum antibiotics to the ED ADC. Data on 56 patients before and 54 patients after the intervention were analyzed. The primary outcome measure was mean order-to-antibiotic time. Secondary outcome measures included mean door-to-antibiotic time and percentage of patients receiving antibiotics within 3 h. Results: The final analysis was on 110 patients. Order-to-antibiotic administration time was reduced by 29 min post-intervention (55 min vs. 26 min, 95percent confidence interval [CI] 12.5-45.19). Mean door-to-antibiotic time was also reduced by 70 min (167 min vs. 97 min, 95percent CI 37.53-102.29). The percentage of severely septic patients receiving antibiotics within 3 h of arrival to the ED increased from 65percent pre-intervention to 93percent post-intervention (95percent CI 0.12-0.42). Conclusion: Storing key antibiotics in an institution's severe sepsis antibiogram in the ED ADC can significantly reduce order-to-antibiotic times and increase the percentage of patients receiving antibiotics within the recommended 3 h of ED arrival. © 2012 Elsevier Inc. All rights reserved.
dc.format.extent
dc.format.extent Pages: (462-469)
dc.language English
dc.publisher NEW YORK
dc.relation.ispartof Publication Name: Journal of Emergency Medicine; Publication Year: 2012; Volume: 42; no. 4; Pages: (462-469);
dc.relation.ispartofseries
dc.relation.uri
dc.source Scopus
dc.subject.other
dc.title Improving door-to-antibiotic time in severely septic emergency department patients
dc.type Article
dc.contributor.affiliation Hitti, E.A., Department of Emergency Medicine, American University, Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh - Beirut 1107 2020, Lebanon
dc.contributor.affiliation Lewin III, J.J., Departments of Pharmacy and Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States
dc.contributor.affiliation Lopez, J., Department of Emergency Medicine, Franklin Square Hospital Center, Baltimore, MD, United States
dc.contributor.affiliation Hansen, J., Department of Emergency Medicine, Franklin Square Hospital Center, Baltimore, MD, United States
dc.contributor.affiliation Pipkin, M., Department of Emergency Medicine, Franklin Square Hospital Center, Baltimore, MD, United States
dc.contributor.affiliation Itani, T., American University, Beirut Medical Center, Beirut, Lebanon
dc.contributor.affiliation Gurny, P., Professional Faculty, Johns Hopkins University Carey School of Business, School of Medicine, Baltimore, MD, United States
dc.contributor.authorAddress Hitti, E.A.; Department of Emergency Medicine, American University, Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh - Beirut 1107 2020, Lebanon
dc.contributor.authorCorporate University: American University of Beirut Medical Center; Faculty: Faculty of Medicine; Department: Emergency Medicine;
dc.contributor.authorDepartment Emergency Medicine
dc.contributor.authorDivision
dc.contributor.authorEmail
dc.contributor.authorFaculty Faculty of Medicine
dc.contributor.authorInitials Hitti, EA
dc.contributor.authorInitials Lewin, JJ
dc.contributor.authorInitials Lopez, J
dc.contributor.authorInitials Hansen, J
dc.contributor.authorInitials Pipkin, M
dc.contributor.authorInitials Itani, T
dc.contributor.authorInitials Gurny, P
dc.contributor.authorOrcidID
dc.contributor.authorReprintAddress Hitti, EA (reprint author), Amer Univ Beirut, Med Ctr, Dept Emergency Med, POB 11 0236, Beirut 11072020, Lebanon.
dc.contributor.authorResearcherID
dc.contributor.authorUniversity American University of Beirut Medical Center
dc.description.cited Angus DC, 2001, CRIT CARE MED, V29, P1303, DOI 10.1097-00003246-200107000-00002; Cubeddu RJ, 2009, J INVASIVE CARDIOL, V21, P518; Dellinger RP, 2008, CRIT CARE MED, V36, P296, DOI 10.1097-01.CCM.0000298158.12101.41; GRECO PJ, 1993, NEW ENGL J MED, V329, P1271, DOI 10.1056-NEJM199310213291714; Hayward RSA, 1997, CAN MED ASSOC J, V156, P1725; Joint Commission on Accreditation of Healthcare Organizations. Medication management, 2009, COMPR ACCR MAN HOSP, P14; Kumar A, 2006, CRIT CARE MED, V34, P1589, DOI 10.1016-j.ccc.2009.08.004; Levy MM, 2003, CRIT CARE MED, V31, P1250, DOI 10.1097-01.CCM.0000050454.01978.3B; Lewin Group, 2002, EM DEP OV GROW CRIS; LOMAS J, 1989, NEW ENGL J MED, V321, P1306, DOI 10.1056-NEJM198911093211906; Miro O, 1999, EUR J EMERG MED, V6, P105; Oren E, 2003, AM J HEALTH-SYST PH, V60, P1447; Pronovost P, 2008, BRIT MED J, V337, DOI 10.1136-bmj.a1714; Ray MD, 1995, HOSP PHARM, V30, P20; Ray MD, 1995, HOSP PHARM, V30, P7; Schull MJ, 2004, ANN EMERG MED, V44, P577, DOI 10.1016-j.annemergmed.2004.05.004; Shorr AF, 2007, CRIT CARE MED, V35, P1257, DOI 10.1097-01.CCM.0000261886.65063.CC; Talmor D, 2008, CRIT CARE MED, V36, P1168, DOI 10.1097-CCM.0b013e318168f649; Varpula M, 2007, ACTA ANAESTH SCAND, V51, P1320, DOI 10.1111-j.1399-6576.2007.01439.x; Wang HE, 2007, CRIT CARE MED, V35, P1928, DOI 10.1097-01.CCM.0000277043.85378.C1
dc.description.citedCount 4
dc.description.citedTotWOSCount 5
dc.description.citedWOSCount 5
dc.format.extentCount 8
dc.identifier.articleNo
dc.identifier.coden JEMMD
dc.identifier.pubmedID 21737222
dc.identifier.scopusID 84859725864
dc.identifier.url
dc.publisher.address 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA
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dc.relation.ispartofConferenceCode
dc.relation.ispartofConferenceDate
dc.relation.ispartofConferenceHosting
dc.relation.ispartofConferenceLoc
dc.relation.ispartofConferenceSponsor
dc.relation.ispartofConferenceTitle
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dc.relation.ispartOfISOAbbr J. Emerg. Med.
dc.relation.ispartOfIssue 4
dc.relation.ispartOfPart
dc.relation.ispartofPubTitle Journal of Emergency Medicine
dc.relation.ispartofPubTitleAbbr J. Emerg. Med.
dc.relation.ispartOfSpecialIssue
dc.relation.ispartOfSuppl
dc.relation.ispartOfVolume 42
dc.source.ID WOS:000303225700020
dc.type.publication Journal
dc.subject.otherAuthKeyword antibiotics
dc.subject.otherAuthKeyword automated dispensing cabinet
dc.subject.otherAuthKeyword emergency department
dc.subject.otherAuthKeyword sepsis
dc.subject.otherAuthKeyword timing
dc.subject.otherChemCAS vancomycin, 1404-90-6, 1404-93-9
dc.subject.otherChemCAS Anti-Bacterial Agents
dc.subject.otherIndex piperacillin plus tazobactam
dc.subject.otherIndex vancomycin
dc.subject.otherIndex article
dc.subject.otherIndex automated dispensing cabinet
dc.subject.otherIndex automation
dc.subject.otherIndex disease severity
dc.subject.otherIndex drug storage
dc.subject.otherIndex emergency care
dc.subject.otherIndex emergency ward
dc.subject.otherIndex hospital admission
dc.subject.otherIndex human
dc.subject.otherIndex major clinical study
dc.subject.otherIndex observational study
dc.subject.otherIndex practice guideline
dc.subject.otherIndex priority journal
dc.subject.otherIndex retrospective study
dc.subject.otherIndex sepsis
dc.subject.otherIndex treatment outcome
dc.subject.otherIndex Adult
dc.subject.otherIndex Anti-Bacterial Agents
dc.subject.otherIndex Emergency Service, Hospital
dc.subject.otherIndex Female
dc.subject.otherIndex Humans
dc.subject.otherIndex Logistic Models
dc.subject.otherIndex Male
dc.subject.otherIndex Practice Guidelines as Topic
dc.subject.otherIndex Retrospective Studies
dc.subject.otherIndex Sepsis
dc.subject.otherIndex Time Factors
dc.subject.otherKeywordPlus SEVERE SEPSIS
dc.subject.otherKeywordPlus MYOCARDIAL-INFARCTION
dc.subject.otherKeywordPlus PRACTICE GUIDELINES
dc.subject.otherKeywordPlus UNITED-STATES
dc.subject.otherKeywordPlus COSTS
dc.subject.otherKeywordPlus SHOCK
dc.subject.otherKeywordPlus MANAGEMENT
dc.subject.otherKeywordPlus PHYSICIANS
dc.subject.otherKeywordPlus PROTOCOL
dc.subject.otherWOS Emergency Medicine


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