Emergency department triage associated with timeliness of care for patients with septic shock.

STUDY

OBJECTIVE

Among emergency department (ED) patients with septic shock, assess the association between high- versus low-priority triage assignment on delays in care.

METHODS

Retrospective cohort study of ED encounters from 2016 to 2020 across 21 community EDs. All EDs used the Emergency Severity Index (ESI) to triage patients. Patients were included if they had an ED or hospital diagnosis of septic shock and received intravenous antibiotics and vasopressors in the ED. Patients were categorized as receiving a high- (ESI I or II) versus low- priority triage assignment (ESI III - V). Outcomes included four measures of timeliness of care and 30-day mortality.

RESULTS

Among 8601 patient encounters; median age was 71.0, 4452 (51.8 %) were male and 1159 (13.5 %), 887 (10.3 %), 4611 (53.6 %), 1287 (15.0 %), and 657 (7.6 %) were Asian, Black, Non-Hispanic White, Hispanic, and other, respectively. We found 7071 (82.2 %) patients received a high-priority triage assignment. The mean adjusted differences between high- and low-priority patients in initial orders, antibiotic delivery, vasopressor delivery, and ED length of stay were 4.6 min (95 % CI 4.2-4.9 min), 34.4 min (95 % CI 31.0-37.8 min), 27.5 min (95 % CI 25.5 min - 29.5 min), and 51.6 min (95 % CI 44.8 min - 58.2 min), respectively. The mean adjusted 30-day mortality rates among high- and low-priority triage patients were 36.3 % (95 % CI 24.5% - 53.8 %) and 32.7 % (21.9 % - 48.9 %), respectively.

CONCLUSION

Lower triage priority is associated with delays in care for patients with septic shock. Early identification is critical to ensure timely care and improved outcomes.