Daniel M. Lindberg, MD reviewing Peltan ID et al. Crit Care Med 2017 Jun.

Individual physicians' median time to antibiotic treatment varied fivefold.

Early administration of appropriate antibiotics very clearly decreases mortality for patients with severe sepsis and septic shock. The national core measure for sepsis requires antibiotic administration within 3 hours, while the Surviving Sepsis Campaign aims for <1 hour.

These authors measured median time from emergency department (ED) arrival to antibiotic administration for 40 different attending physicians at a single academic ED in Seattle. Each physician cared for at least five eligible patients; data were adjusted for several potential covariates (e.g., patient age, illness severity).

Of 421 patients, 74% received antibiotics within 3 hours. Among the 40 individual physicians, adjusted median time to antibiotic initiation varied from 71 to 359 minutes. In multivariable modeling, the attending physician was the most significant contributor to variability in antibiotic timing, accounting for 12% of overall variability, compared with 4% attributable to illness severity. Variability was not explained by physician years of experience. Odds of in-hospital mortality increased 20% for each 1-hour delay to antibiotics.

CITATION(S):

Peltan ID et al. Physician variation in time to antimicrobial treatment for septic patients presenting to the emergency department. Crit Care Med 2017 Jun; 45:1011. 

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