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Decreased Time to Antibiotic Prophylaxis for Open Fractures at a Level One Trauma Center
Joey P Johnson1, Avi D Goodman, Adam M Haag
1Departments of *Orthopaedic Surgery, and †Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI; and ‡Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI.
Objective:
To determine whether time to administration of antibiotics decreased after the implementation of an open fracture working group and antibiotic prophylaxis protocol.
Design:
Retrospective cohort study.
Setting:
One Level 1 Trauma Center.
Patients:
Patients 18 years of age and older who sustained an open fracture and presented directly to our emergency department.
Intervention:
Prompt irrigation and debridement in the operating room and fracture stabilization dictated by the treating surgeon. Fifty patients were reviewed as the preintervention group, comprising the period before conception and before intervention. Fifty patients were included after the initiation of our protocol during the same time period 1 year later.
Main Outcome Measurements:
Time from entrance to the emergency department to ordering of antibiotics, time from ordering to administration of antibiotics, and time from entrance to the emergency department to administration of antibiotics.
Results:
After protocol implementation, time from admission to antibiotic administration decreased significantly from 123.1 to 35.7 minutes (P = 0.0003). Each component decreased significantly: admission to order decreased from 94.1 to 26.1 minutes, and order to administration decreased from 29.0 to 9.5 minutes (P = 0.0046 and P = 0.0003).
Conclusion:
Our study demonstrates a significantly reduced time to antibiotic prophylaxis for patients with open fractures after the implementation of a multidisciplinary working group. We hope that this provides a model for institutions to improve care and outcomes of these injuries.
Level Of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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