Physician Variation in Early Sepsis Management

Area of Science:

• Emergency Medicine
• Infectious Diseases
• Health Services Research

Background:

• Prompt antimicrobial therapy is crucial for sepsis management.
• Accelerating antimicrobial administration may risk overtreatment.

Purpose of the Study:

• To analyze physician variation in door-to-antimicrobial time for sepsis.
• To determine if faster sepsis treatment is associated with overtreatment.

Main Methods:

• Mixed-methods study combining retrospective quantitative data (2013-2017) and qualitative interviews (2022-2023).
• Analysis of 9810 sepsis patients and 88 emergency department physicians across 4 Utah EDs.
• Statistical modeling to assess variation and overtreatment; cognitive task analysis for physician interviews.

Main Results:

• Significant physician variation in door-to-antimicrobial time (median 184 minutes).
• Faster antimicrobial administration was not associated with increased overtreatment (P=.37).
• Physicians with faster times reported proactive, parallel task execution and team coordination.

Conclusions:

• Emergency department physicians exhibit considerable variation in sepsis antimicrobial timing.
• Initiating antimicrobials faster does not appear to increase overtreatment risk.
• Proactive care coordination characterizes physicians with shorter door-to-antimicrobial times.