Impact of intravenous push antibiotics on sepsis management at a Veterans Affairs medical center emergency department.

OBJECTIVE

To detail the impact of transitioning from intravenous piggyback (IVPB) to intravenous push (IVP) antibiotics on median time from sepsis identification to antibiotic administration (minutes), proportion of septic patients who received antibiotics within 60 and 180 minutes of sepsis identification, and Emergency Department (ED) length of stay (LOS).

DESIGN

Retrospective chart review.

SETTING

Urban, acute-care hospital.

PARTICIPANTS

394 patients received IVPB antibiotics (June 2022-June 2023) and 421 patients received IVP antibiotics (June 2023-June 2024), identified through sepsis-related ICD-10 codes, systemic inflammatory response syndrome (SIRS) criteria, and other clinical indicators.

METHODS

Chart reviews were conducted to obtain sepsis identification and antibiotic administration start times. Statistical process control was used to monitor trends and assess process consistency over time.

RESULTS

Following our intervention, median time from sepsis identification to antibiotic administration decreased from 132 minutes (IQR 70, 194) in the IVPB group to 99 minutes (IQR 56,164) in the IVP group (P < .001). The proportion of patients who received antibiotics within 60 minutes of sepsis identification increased from 20.3% to 28.0% (P = .01) and within 180 minutes increased from 70.8% to 79.8% (P = .003). ED LOS decreased from 397 minutes with IVPB to 369 minutes with IVP (P = .004). A sustained downward shift of twelve consecutive months of mean sepsis identification to antibiotic administration start time below the pre-intervention centerline was observed.

CONCLUSIONS

IVP antibiotics were associated with decreased median time from sepsis identification to antibiotic administration for septic patients, increased adherence to practice guidelines, and reduced ED LOS.