(1403) Reducing Antibiotic Delays for Regular Nursing Floor Patients: Experience of a Sepsis Response Team

Introduction: Hospital-onset sepsis (HOS) is associated with high mortality, and suboptimal care delivery may be a contributing factor. Coordinating care across multiple regular nursing floors (RNFs) of large academic medical centers (AMCs) with multiple primary treatment teams represents a challenge to standardized sepsis management. Here we present a quality improvement effort aimed at reducing delays in antibiotic administration conducted by a sepsis team dedicated to early identification and treatment of patients with sepsis on RNFs.

Methods: The Sepsis Emergency Response Team (SERT) is active across 950 adult RNF beds at an AMC in Cleveland, OH. SERT is staffed by advanced practice providers (APPs) who screen patients for sepsis using an electronic alert and assist primary treatment teams with initiating diagnostic and therapeutic interventions. SERT conducts routine multi-disciplinary event reviews to improve care delivery, including the percent of patients with likely sepsis receiving antibiotics within one hour of order (order-to-administration < 1 hour (OTA)). During the study period from June 2022 through February 2024, SERT categorized relevant contributors to delays in antibiotic OTA using a root cause analysis process and instituted indicated adjustments to staffing and workflow.

Results: Baseline antibiotic OTA was 51.8% among 83 patients with likely sepsis. The most common reasons for delayed antibiotic administration were: inter-team communication, not ordering antibiotics STAT, and time spent obtaining blood cultures contributing to 22%, 21%, and 15% of delays respectively. Key adjustments to the SERT program included mandating SERT APP presence at the bedside for all patients requiring new antibiotics and increasing dedicated nursing and phlebotomy support for relevant SERT activations. OTA improved to 88.2% among 110 patients in the post-study period.

Conclusions: A sepsis team dedicated to patients on RNFs provides a quality improvement platform to identify reasons for delays in antibiotic OTA at a large AMC. Utilizing a multi-disciplinary review process, we identified and intervened upon several reasons for delayed OTA. Further study is needed to determine the association between these interventions and clinical outcomes in this patient cohort.