PLoS ONE (Jan 2016)

Predictors for Delayed Emergency Department Care in Medical Patients with Acute Infections - An International Prospective Observational Study.

  • Alexander Kutz,
  • Jonas Florin,
  • Pierre Hausfater,
  • Devendra Amin,
  • Adina Amin,
  • Sebastian Haubitz,
  • Antoinette Conca,
  • Barbara Reutlinger,
  • Pauline Canavaggio,
  • Gabrielle Sauvin,
  • Maguy Bernard,
  • Andreas Huber,
  • Beat Mueller,
  • Philipp Schuetz,
  • TRIAGE Study group

DOI
https://doi.org/10.1371/journal.pone.0155363
Journal volume & issue
Vol. 11, no. 5
p. e0155363

Abstract

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INTRODUCTION:In overcrowded emergency department (ED) care, short time to start effective antibiotic treatment has been evidenced to improve infection-related clinical outcomes. Our objective was to study factors associated with delays in initial ED care within an international prospective medical ED patient population presenting with acute infections. METHODS:We report data from an international prospective observational cohort study including patients with a main diagnosis of infection from three tertiary care hospitals in Switzerland, France and the United States (US). We studied predictors for delays in starting antibiotic treatment by using multivariate regression analyses. RESULTS:Overall, 544 medical ED patients with a main diagnosis of acute infection and antibiotic treatment were included, mainly pneumonia (n = 218; 40.1%), urinary tract (n = 141; 25.9%), and gastrointestinal infections (n = 58; 10.7%). The overall median time to start antibiotic therapy was 214 minutes (95% CI: 199, 228), with a median length of ED stay (ED LOS) of 322 minutes (95% CI: 308, 335). We found large variations of time to start antibiotic treatment depending on hospital centre and type of infection. The diagnosis of a gastrointestinal infection was the most significant predictor for delay in antibiotic treatment (+119 minutes compared to patients with pneumonia; 95% CI: 58, 181; p<0.001). CONCLUSIONS:We found high variations in hospital ED performance in regard to start antibiotic treatment. The implementation of measures to reduce treatment times has the potential to improve patient care.