Impact of 1-hour and 3-hour sepsis time bundles on antibiotic use in emergency departments in Queensland, Australia: a before-and-after cohort study
Objective To determine if the introduction of an emergency department (ED) sepsis screening tool and management bundle affects antibiotic prescribing and use.Design Multicentre, cohort, before-and-after study design.Setting Three tertiary hospitals in Queensland, Australia (median bed size 543, rang...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/9/e072167.full |
| _version_ | 1797669503165792256 |
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| author | Paul Lane Kristen Gibbons Michael Rice Balasubramanian Venkatesh Donna Mason Kathryn Wilks Robert Seaton Lyndell Redpath Endrias Ergetu |
| author_facet | Paul Lane Kristen Gibbons Michael Rice Balasubramanian Venkatesh Donna Mason Kathryn Wilks Robert Seaton Lyndell Redpath Endrias Ergetu |
| author_sort | Paul Lane |
| collection | DOAJ |
| description | Objective To determine if the introduction of an emergency department (ED) sepsis screening tool and management bundle affects antibiotic prescribing and use.Design Multicentre, cohort, before-and-after study design.Setting Three tertiary hospitals in Queensland, Australia (median bed size 543, range 520–742).Participants Adult patients, presenting to the ED with symptoms and signs suggestive of sepsis who had blood cultures collected. These participants were further assessed and stratified as having septic shock, sepsis or infection alone, using Sepsis-3 definitions. The study dates were 1 July 2017–31 March 2020.Intervention The breakthrough series collaborative ‘Could this be Sepsis?’ Programme, aimed at embedding a sepsis screening tool and treatment bundle with weighted-incidence syndromic combined antibiogram-derived antibiotic guidelines in EDs.Main outcome measures The primary outcome was the rate of empirical prescriptions adherent to antibiotic guidelines during the ED encounter. Secondary outcomes included the empirical prescriptions considered appropriate, effective antibiotics administered within 3 hours and assessment of harm measures.Results Of 2591 eligible patients, 721 were randomly selected: 241 in the baseline phase and 480 in the post-intervention phase. The rates of guideline adherence were 54.0% and 59.5%, respectively (adjusted OR (aOR) 1.41 (95% CI 1.00, 1.98)). As compared with baseline, there was an increase in the rates of appropriate antibiotic prescription after bundle implementation (69.9% vs 57.1%, aOR 1.92 (95% CI 1.37, 2.68)). There were no differences between the baseline and post-intervention groups with respect to time to effective antibiotics, adverse effects or ED rates of broad-spectrum antibiotic use.Conclusion and relevance The use of an ED sepsis screening tool and management bundle was associated with an improvement in the rates of appropriate antibiotic prescription without evidence of adverse effects. |
| first_indexed | 2024-03-11T20:45:20Z |
| format | Article |
| id | doaj.art-613f0dcf757d4f158a111e9581002aa5 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-11T20:45:20Z |
| publishDate | 2023-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-613f0dcf757d4f158a111e9581002aa52023-10-01T14:20:08ZengBMJ Publishing GroupBMJ Open2044-60552023-09-0113910.1136/bmjopen-2023-072167Impact of 1-hour and 3-hour sepsis time bundles on antibiotic use in emergency departments in Queensland, Australia: a before-and-after cohort studyPaul Lane0Kristen Gibbons1Michael Rice2Balasubramanian Venkatesh3Donna Mason4Kathryn Wilks5Robert Seaton6Lyndell Redpath7Endrias Ergetu8Department of Medicine, The Prince Charles Hospital, Chermside, Queensland, AustraliaChild Health Research Centre, Mater Medical Research Institute, South Brisbane, Queensland, AustraliaClinical Excellence Queensland, Queensland Health, Brisbane, Queensland, AustraliaThe George Institute for Global Health, Newtown, New South Wales, AustraliaClinical Excellence Queensland, Queensland Health, Brisbane, Queensland, AustraliaSchool of Public Health, The University of Queensland, Saint Lucia, Queensland, AustraliaClinical Excellence Queensland, Queensland Health, Brisbane, Queensland, AustraliaClinical Excellence Queensland, Queensland Health, Brisbane, Queensland, AustraliaChild Health Research Centre, Mater Medical Research Institute, South Brisbane, Queensland, AustraliaObjective To determine if the introduction of an emergency department (ED) sepsis screening tool and management bundle affects antibiotic prescribing and use.Design Multicentre, cohort, before-and-after study design.Setting Three tertiary hospitals in Queensland, Australia (median bed size 543, range 520–742).Participants Adult patients, presenting to the ED with symptoms and signs suggestive of sepsis who had blood cultures collected. These participants were further assessed and stratified as having septic shock, sepsis or infection alone, using Sepsis-3 definitions. The study dates were 1 July 2017–31 March 2020.Intervention The breakthrough series collaborative ‘Could this be Sepsis?’ Programme, aimed at embedding a sepsis screening tool and treatment bundle with weighted-incidence syndromic combined antibiogram-derived antibiotic guidelines in EDs.Main outcome measures The primary outcome was the rate of empirical prescriptions adherent to antibiotic guidelines during the ED encounter. Secondary outcomes included the empirical prescriptions considered appropriate, effective antibiotics administered within 3 hours and assessment of harm measures.Results Of 2591 eligible patients, 721 were randomly selected: 241 in the baseline phase and 480 in the post-intervention phase. The rates of guideline adherence were 54.0% and 59.5%, respectively (adjusted OR (aOR) 1.41 (95% CI 1.00, 1.98)). As compared with baseline, there was an increase in the rates of appropriate antibiotic prescription after bundle implementation (69.9% vs 57.1%, aOR 1.92 (95% CI 1.37, 2.68)). There were no differences between the baseline and post-intervention groups with respect to time to effective antibiotics, adverse effects or ED rates of broad-spectrum antibiotic use.Conclusion and relevance The use of an ED sepsis screening tool and management bundle was associated with an improvement in the rates of appropriate antibiotic prescription without evidence of adverse effects.https://bmjopen.bmj.com/content/13/9/e072167.full |
| spellingShingle | Paul Lane Kristen Gibbons Michael Rice Balasubramanian Venkatesh Donna Mason Kathryn Wilks Robert Seaton Lyndell Redpath Endrias Ergetu Impact of 1-hour and 3-hour sepsis time bundles on antibiotic use in emergency departments in Queensland, Australia: a before-and-after cohort study BMJ Open |
| title | Impact of 1-hour and 3-hour sepsis time bundles on antibiotic use in emergency departments in Queensland, Australia: a before-and-after cohort study |
| title_full | Impact of 1-hour and 3-hour sepsis time bundles on antibiotic use in emergency departments in Queensland, Australia: a before-and-after cohort study |
| title_fullStr | Impact of 1-hour and 3-hour sepsis time bundles on antibiotic use in emergency departments in Queensland, Australia: a before-and-after cohort study |
| title_full_unstemmed | Impact of 1-hour and 3-hour sepsis time bundles on antibiotic use in emergency departments in Queensland, Australia: a before-and-after cohort study |
| title_short | Impact of 1-hour and 3-hour sepsis time bundles on antibiotic use in emergency departments in Queensland, Australia: a before-and-after cohort study |
| title_sort | impact of 1 hour and 3 hour sepsis time bundles on antibiotic use in emergency departments in queensland australia a before and after cohort study |
| url | https://bmjopen.bmj.com/content/13/9/e072167.full |
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