Relationship between time of emergency department admission and adherence to the Surviving Sepsis Campaign bundle in patients with septic shock

Je Sung You, Yoo Seok Park, Sung Phil Chung, Hye Sun Lee, Soyoung Jeon, Won Young Kim, Tae Gun Shin, You Hwan Jo, Gu Hyun Kang, Sung Hyuk Choi, Gil Joon Suh, Byuk Sung Ko, Kap Su Han, Jong Hwan Shin, Taeyoung Kong, Korean Shock Society (KoSS) Investigators, Won Young Kim, Seung Mok Ryoo, Tae Gun Shin, Sung Yeon Hwang, You Hwan Jo, Sung Phil Chung, Yoon Jung Hwang, Jin Ho Beom, Yoo Seok Park, Gu Hyun Kang, Sung-Hyuk Choi, Young-Hoon Yoon, Gil Joon Suh, Tae Ho Lim, Byuk Sung Ko, Kap Su Han, Jong Hwan Shin, Hui Jai Lee, Kyoung Min You, Je Sung You, Yoo Seok Park, Sung Phil Chung, Hye Sun Lee, Soyoung Jeon, Won Young Kim, Tae Gun Shin, You Hwan Jo, Gu Hyun Kang, Sung Hyuk Choi, Gil Joon Suh, Byuk Sung Ko, Kap Su Han, Jong Hwan Shin, Taeyoung Kong, Korean Shock Society (KoSS) Investigators, Won Young Kim, Seung Mok Ryoo, Tae Gun Shin, Sung Yeon Hwang, You Hwan Jo, Sung Phil Chung, Yoon Jung Hwang, Jin Ho Beom, Yoo Seok Park, Gu Hyun Kang, Sung-Hyuk Choi, Young-Hoon Yoon, Gil Joon Suh, Tae Ho Lim, Byuk Sung Ko, Kap Su Han, Jong Hwan Shin, Hui Jai Lee, Kyoung Min You

Abstract

Background: Nighttime hospital admission is often associated with increased mortality risk in various diseases. This study investigated compliance rates with the Surviving Sepsis Campaign (SSC) 3-h bundle for daytime and nighttime emergency department (ED) admissions and the clinical impact of compliance on mortality in patients with septic shock.

Methods: We conducted an observational study using data from a prospective, multicenter registry for septic shock provided by the Korean Shock Society from 11 institutions from November 2015 to December 2017. The outcome was the compliance rate with the SSC 3-h bundle according to the time of arrival in the ED.

Results: A total of 2049 patients were enrolled. Compared with daytime admission, nighttime admission was associated with higher compliance with the administration of antibiotics within 3 h (adjusted odds ratio (adjOR), 1.326; 95% confidence interval (95% CI), 1.088-1.617, p = 0.005) and with the complete SSC bundle (adjOR, 1.368; 95% CI, 1.115-1.678; p = 0.003), likely to result from the increased volume of all patients and sepsis patients admitted during daytime hours. The hazard ratios of the completion of SSC bundle for 28-day mortality and in-hospital mortality were 0.750 (95% CI 0.590-0.952, p = 0.018) and 0.714 (95% CI 0.564-0.904, p = 0.005), respectively.

Conclusion: Septic shock patients admitted to the ED during the daytime exhibited lower sepsis bundle compliance than those admitted at night. Both the higher number of admitted patients and the higher patients to medical staff ratio during daytime may be factors that are responsible for lowering the compliance.

Keywords: Off-hour effect; Sepsis; Septic shock; Surviving Sepsis Campaign.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow diagram of patient inclusion and exclusion. KoSS Korean Shock Society, MAP mean arterial pressure
Fig. 2
Fig. 2
The patient to doctor ratio according to time zone in emergency department and the compliance rate for the complete Surviving Sepsis Campaign 3-h bundle. The bars indicate the patient to doctor ratio. The compliance rate for the complete sepsis bundle is shown by the dashed line, and the average 28-day mortality rate in the daytime and nighttime is represented by the solid line
Fig. 3
Fig. 3
Relationships between the adherence to the SSC 3-h bundle, 28-day mortality (A) and in-hospital mortality (B). The completion of SSC 3-h bundle was significantly associated with a decreased 28-day and in-hospital mortality risk among patients with septic shock. HR hazard ratio, 95% CI 95% confidence interval, SSC Surviving Sepsis Campaign

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Source: PubMed

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