Sepsis Screening in Triage to Decrease Door-to-Antibiotic Time

Identifying patients with sepsis at triage can lead to a decrease in door-to-antibiotic time. Our community hospital emergency department's mean door-to-antibiotic time was 105.3 minutes, falling short of the Surviving Sepsis Campaign guideline's benchmark goal of 60 minutes. One of the most common reasons for treatment delays was that patients with sepsis were not identified upon entrance to the emergency department. A solution to the delay was to implement a practice improvement project by having the triage nurse screen all patients for sepsis upon entrance to the emergency department.

A sepsis-screening tool was used to identify patients with sepsis and was based on systemic inflammatory response syndrome (SIRS) criteria. Patients screening positive were prioritized for ED bed space. The change in process allowed more rapid ED physician evaluation and antibiotic administration. Manual chart abstraction was used to calculate door-to-antibiotic time and included 12 months of preintervention data and 2 months of postintervention data.

Door-to-antibiotic time improved from a baseline of 105.3 minutes to 71.9 minutes.

The simple change in patient throughput improved door-to-antibiotic time with minimal obstacles. The sepsis-screening tool implemented at triage decreased the door-to-antibiotic time by 33.4 minutes, without affecting triage time, and enhanced patient throughput of potentially septic patients.