B104-03 Nighttime Presentation Is Associated With Shorter Time to Antibiotic Administration in Emergency Department Patients With Sepsis

Rationale Timely antibiotic administration improves outcomes in sepsis, yet treatment delays remain common. How the organization and resource availability of emergency department (ED) care influence the timeliness of sepsis treatment is less well understood. Day-versus-night differences in care processes provide one way to examine this issue. Prior studies examining temporal variation in sepsis care have shown mixed results. We evaluated whether ED arrival during nighttime hours was associated with differences in time to antibiotic administration compared with daytime presentation. This comparison provides a framework to examine how ED organization and resource availability influence timely, high-quality sepsis care. Methods We conducted a retrospective cohort study of adults (≥18 years) meeting Sepsis-3 criteria who presented to four EDs within an integrated healthcare system between July 2013 and January 2017. The primary exposure was ED arrival time, categorized as nighttime (00:00–06:59) or daytime (07:00–23:59). The primary outcome was time from ED arrival to first antibiotic administration. Secondary outcomes were antibiotic administration within 1 and 3 hours of arrival. Multivariable linear (continuous) and logistic (binary) regression models were adjusted for age, partnership status, Charlson Comorbidity Index, ED acuity, SOFA score, GCS ≤13, mean arterial pressure, arrival mode, recent admission, preferred language, weekend arrival, and race. Results Among 12,681 patients with sepsis, patients were predominantly older adults with multiple comorbidities and high illness severity, typical of an ED sepsis population. In unadjusted analysis, mean door-to-antibiotic time was 185 ± 94 minutes for daytime and 173 ± 102 minutes for nighttime presentations, a mean difference of –12 minutes (95% CI –17 to –7; p < 0.001; Table 1). After adjustment, the mean door-to-antimicrobial time was 11 minutes faster for patients presenting at night (95% CI –16 to –6; p = 0.003). Nighttime arrivals also had higher odds of receiving antibiotics within 1 hour (adjusted OR 1.41; 95% CI 1.26–1.59; p < 0.001) and within 3 hours (adjusted OR 1.40; 95% CI 1.25–1.56; p < 0.001). Conclusions Contrary to expectations that reduced nighttime staffing and ancillary resources might delay care, sepsis patients presenting overnight received antibiotics more promptly than those arriving during the day. Identifying organizational factors and care processes that facilitate efficient sepsis evaluation and treatment overnight may aid design of care systems that ensure high-quality sepsis care. This abstract is funded by: None