Lower ED Triage Scores Linked to Antibiotic Delays for Sepsis Patients

Ithan D. Peltan, MD, MSc

Hospital emergency departments commonly use a 1 to 5 acuity scale to triage arriving patients and prioritize care for the most critical cases. However, the scale is subjective and the difference between an acuity score of 2 versus 3 can mean a half hour difference in how quickly antibiotics are administered to patients with sepsis, according to a new study.

Investigators at the University of Utah Medical School and Intermountain Healthcare hospital system chose to look at outcomes for patients with sepsis because the timing of antibiotic treatment for the life-threatening infection can make a difference in a patient’s likelihood of survival.

“Triaging patients and delivering antibiotics quickly in the emergency department is a constant challenge,” said Sierra R. McLean, a University of Utah medical student and the study’s lead author. “We’re trying to figure out ways to provide better quality care to patients, and this study shows us we need to come up with interventions to make sure very-ill sepsis patients are appropriately recognized to help get their antibiotics on time.”

The research, which was presented at the 2019 American Thoracic Society (ATS) International Conference in Dallas, TX, pulled data from the emergency departments at 4 Intermountain Healthcare hospitals in Utah between July 2013 and January 2017. Investigators focused on patients with sepsis who had abnormally low blood pressure (<90 mmHg systolic and/or mean arterial pressure <65 mmHg) and were assigned a 2 (emergent) or 3 (urgent) on the scale where 1 is the most critical and 5 is the least critical.

Of the 937 patients eligible for the retrospective cohort study, 694 were given an acuity score of “emergent” and 243 were given an “urgent” score. Patients with the lower “urgent” score were older, more likely to be female, and had more severe physiologic derangements.

After adjustments for the hospital, age, sex and other factors, patients who had triage scores of “urgent” waited 30 minutes (95% Confidence Interval, 16 to 43 minutes) longer than patients with triage scores of “emergent” (P <.001).

US and international care standards recommend that patients with sepsis begin receiving broad-spectrum antibiotics within 3 hours of arriving at the emergency department said Ithan D. Peltan, MD, MSc, senior author of the study and an attending physician in the Intermountain Medical Center Shock Trauma Intensive Care Unit and Intermountain Healthcare Telecritical Care. He pointed out that the half hour difference can “make a major difference in a patient’s chances for survival.”

McLean said that increasing the timely administration of antibiotics for patients with sepsis might lie in developing interventions to improve the triage process.

“How do we help these incredibly busy, skilled ED clinicians—who are working in an environment where there’s not much information&mdash;to identify sepsis patients who are at risk for under-triage?” Peltan asked. “This study is a step toward answering that question.”

The abstract, “Lower Triage Acuity Scores Are Associated with Delayed Antibiotics in ED Sepsis,” was presented on May 22 at the ATS 2019 International Conference.