Risk classification and door-to-antibiotic time in patients with suspected sepsis.
Ana Paula Souza Lima, Gláucio de Oliveira Nangino, Fabiana Fernandes Rego Soares and 3 others
PMID 38055588WHAT IT FOUND
Risk classification did not reduce door-to-antibiotic time overall.
However, patients assigned high priority received antibiotics significantly faster than those with low priority or no classification. The speed of care depended on the urgency assigned, not just on being triaged.
Key findings
01Door-to-antibiotic time did not differ significantly between patients who received risk classification and those who did not.
02Patients with high priority risk classification (orange or red) had significantly lower door-to-antibiotic times compared to intermediate, low priority, and unclassified groups.
03There was no association between door-to-antibiotic time and hospital outcomes such as ICU admission, infirmary admission, or survival.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was retrospective and observational, so patients were not randomly assigned to triage; they were classified based on whether they arrived during triage operating hours. Risk classification was unavailable at night and on weekends, creating a natural control group that may differ systematically in patient acuity or staffing levels. The study period coincided with the COVID-19 pandemic, which altered emergency department workflows and restricted triage to patients without flu-like symptoms. Waiting time within the triage queue itself was not measured, so it is unclear if delays occurred before or after classification. The sample size was relatively small (232 patients) and from a single center. The triage protocol used did not yet include a specific 'possible sepsis' discriminator, which is present in newer versions of the Manchester Triage System.
Declared interests
The paper does not report any specific conflicts of interest or funding sources in the provided text.
The easy way to misread this
Do not conclude that implementing a triage system will reduce antibiotic delays for all sepsis patients. The overall effect was null; only patients correctly identified as high priority received faster treatment. A patient classified as low priority may wait as long as or longer than a patient who was never triaged.