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Interhospital Transfer Delays Appropriate Treatment for Patients With Severe Sepsis and Septic Shock: A Retrospective Cohort Study.
Crit Care Med. 2015 Dec; 43(12):2589-96.CC

Abstract

OBJECTIVE

To test the hypothesis that interhospital transfer causes significant delays in the administration of appropriate antibiotics and compliance with the completion of Surviving Sepsis Bundle elements.

DESIGN

Single-center retrospective cohort study.

SETTING

A comprehensive 60,000-visit emergency department at a 711-bed Midwestern academic medical center.

PATIENTS

Patients with severe sepsis and septic shock treated between 2009 and 2014 were identified by International Classification of Diseases,9th Revision, Clinical Modification, codes, then divided into two cohorts: 1) transfer patients who arrived at the tertiary academic center after receiving care in a local community hospital and 2) control patients who presented directly to the tertiary academic center emergency department.

INTERVENTIONS

None.

MEASUREMENT AND MAIN RESULTS

One hundred ninety-three patients were included. Transfer patients were more likely to require surgery in the hospital (p < 0.001) and require ICU care (p = 0.001) but had similar illness severity based on (Acute Physiology and Chronic Health Evaluation II, 17.7 vs 17.5; p = 0.662). Antibiotic administration at 1 and 3 hours was comparable between the two cohorts, but initial antibiotic appropriateness was lower in transfer patients (34% vs 79%; p < 0.001). Transfer patients were less likely to have fluid resuscitation started by 3 hours (54% vs 89%; p < 0.001), but they were not less likely to receive an adequate fluid bolus (30 mL/kg) by the time of hospital admission (p = 0.056). There were no differences in ICU length of stay or mortality.

CONCLUSIONS

Interhospital transfer significantly delays administration of appropriate initial antibiotics and resuscitation therapy. Future studies are needed to identify strategies of providing regional sepsis care prior to transfer to tertiary centers and to continue care pathways during the interhospital transfer process.

Authors+Show Affiliations

1Department of Emergency Medicine, Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Iowa City, IA. 2Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA. 3Division of Emergency Medicine, Department of Anesthesiology, Division of Critical Care Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO. 4Department of Emergency Medicine, Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26491865

Citation

Faine, Brett A., et al. "Interhospital Transfer Delays Appropriate Treatment for Patients With Severe Sepsis and Septic Shock: a Retrospective Cohort Study." Critical Care Medicine, vol. 43, no. 12, 2015, pp. 2589-96.
Faine BA, Noack JM, Wong T, et al. Interhospital Transfer Delays Appropriate Treatment for Patients With Severe Sepsis and Septic Shock: A Retrospective Cohort Study. Crit Care Med. 2015;43(12):2589-96.
Faine, B. A., Noack, J. M., Wong, T., Messerly, J. T., Ahmed, A., Fuller, B. M., & Mohr, N. M. (2015). Interhospital Transfer Delays Appropriate Treatment for Patients With Severe Sepsis and Septic Shock: A Retrospective Cohort Study. Critical Care Medicine, 43(12), 2589-96. https://doi.org/10.1097/CCM.0000000000001301
Faine BA, et al. Interhospital Transfer Delays Appropriate Treatment for Patients With Severe Sepsis and Septic Shock: a Retrospective Cohort Study. Crit Care Med. 2015;43(12):2589-96. PubMed PMID: 26491865.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interhospital Transfer Delays Appropriate Treatment for Patients With Severe Sepsis and Septic Shock: A Retrospective Cohort Study. AU - Faine,Brett A, AU - Noack,Joseph M, AU - Wong,Terrance, AU - Messerly,Jeffrey T, AU - Ahmed,Azeemuddin, AU - Fuller,Brian M, AU - Mohr,Nicholas M, PY - 2015/10/23/entrez PY - 2015/10/23/pubmed PY - 2016/3/5/medline SP - 2589 EP - 96 JF - Critical care medicine JO - Crit Care Med VL - 43 IS - 12 N2 - OBJECTIVE: To test the hypothesis that interhospital transfer causes significant delays in the administration of appropriate antibiotics and compliance with the completion of Surviving Sepsis Bundle elements. DESIGN: Single-center retrospective cohort study. SETTING: A comprehensive 60,000-visit emergency department at a 711-bed Midwestern academic medical center. PATIENTS: Patients with severe sepsis and septic shock treated between 2009 and 2014 were identified by International Classification of Diseases,9th Revision, Clinical Modification, codes, then divided into two cohorts: 1) transfer patients who arrived at the tertiary academic center after receiving care in a local community hospital and 2) control patients who presented directly to the tertiary academic center emergency department. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: One hundred ninety-three patients were included. Transfer patients were more likely to require surgery in the hospital (p < 0.001) and require ICU care (p = 0.001) but had similar illness severity based on (Acute Physiology and Chronic Health Evaluation II, 17.7 vs 17.5; p = 0.662). Antibiotic administration at 1 and 3 hours was comparable between the two cohorts, but initial antibiotic appropriateness was lower in transfer patients (34% vs 79%; p < 0.001). Transfer patients were less likely to have fluid resuscitation started by 3 hours (54% vs 89%; p < 0.001), but they were not less likely to receive an adequate fluid bolus (30 mL/kg) by the time of hospital admission (p = 0.056). There were no differences in ICU length of stay or mortality. CONCLUSIONS: Interhospital transfer significantly delays administration of appropriate initial antibiotics and resuscitation therapy. Future studies are needed to identify strategies of providing regional sepsis care prior to transfer to tertiary centers and to continue care pathways during the interhospital transfer process. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/26491865/Interhospital_Transfer_Delays_Appropriate_Treatment_for_Patients_With_Severe_Sepsis_and_Septic_Shock:_A_Retrospective_Cohort_Study_ L2 - https://dx.doi.org/10.1097/CCM.0000000000001301 DB - PRIME DP - Unbound Medicine ER -