Effect of Emergency Department Care Reorganization on Door-to-antibiotic Times for Sepsis (LDS SWARM)

Study Overview
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Brief Summary
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Sepsis is a common syndrome resulting from a dysregulated response to infection. The timing of antibiotic initiation is an important determinant of outcomes for patients presenting to the emergency department with sepsis. The potential effect of care reorganization on very early care for sepsis is unknown. This study will investigate whether multidisciplinary coordination of the initial patient evaluation in the emergency department influences door-to-antibiotic time for septic patients.

Detailed Description
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This is a retrospective cohort study of emergency department sepsis care before versus after implementation of a swarming model for simultaneous patient evaluation by multidisciplinary care providers. The analysis will use data from similar hospitals that did not change sepsis care organization during the study period to control for changes in sepsis care not resulting from the swarming intervention.

Official Title
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Effect of Emergency Department Care Reorganization on Door-to-antibiotic Times for Sepsis (LDS SWARM)

Conditions
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Septic Shock, Sepsis

Intervention / Treatment
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* Other: Immediate evaluation by multidisciplinary team


Participation Criteria
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Eligibility Criteria
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Primary inclusion criteria: Adult patients age ≥18 years Presented to the ED of study hospital from May 16, 2015 to April 15, 2016 (pre-implementation cohort) or May 16 to November 15, 2016 (post-implementation cohort) Sepsis present in ED (Sequential Organ Failure Assessment [SOFA] score ≥2 points above baseline while in ED plus antibiotic initiation while in the ED) Triage acuity score 2-5 Inclusion criteria for supplemental sensitivity analyses: Presented to the ED of study hospital between May 16, 2015 and April 15, 2016 (pre-implementation cohort) or May 16, 2016 and February 15, 2017 (post-implementation cohort). Sepsis on presentation to ED, defined as initial Sequential Organ Failure Assessment (SOFA) score ≥2 points above baseline plus antibiotics initiation within 24 hours of ED arrival. Overall exclusion criteria: Age <18 years No antibiotics within 24 hours of ED arrival

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pre-implementation (intervention site)<br>Adult patients age ≥18 years who received usual care after presenting to the ED of the intervention hospital with sepsis or septic shock between May 16, 2015 and April 15, 2016 | |
| Post-implementation (intervention site)<br>Adult patients age ≥18 years eligible to receive immediate evaluation by multidisciplinary team (swarming) after presenting to the ED of the intervention hospital with sepsis or septic shock between May 16, 2016 and February 15, 2017 | Other: Immediate evaluation by multidisciplinary team<br>* Simultaneous initial evaluation by the ED physician, nurse, and patient care associate<br>* Other names: Swarming;|
| Pre-implementation (control site)<br>Adult patients age ≥18 years who received usual care after presenting to the ED of a non-intervention study hospital with sepsis or septic shock between May 16, 2015 and April 15, 2016 | |
| Post-implementation (control site)<br>Adult patients age ≥18 years who received usual care after presenting to the ED of a non-intervention study hospital with sepsis or septic shock between May 16, 2016 and February 15, 2017 | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time From ED Arrival to Administration of First Dose of Antibiotics |  | 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital Mortality |  | Up to 1 year | 
| ED Length of Stay | Time (minutes) from ED arrival to ED departure | Up to 1 week | 
| Door-to-physician Evaluation Time | Time (minutes) from subject's arrival in the ED until initial evaluation by a physician. | Up to 24 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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door-to-antibiotic time, emergency department care, antimicrobial, care reorganization, severe sepsis, swarming