B104-02 Emergency Department Census and Time to Antimicrobial Administration in Sepsis

Abstract Rationale Delays in antimicrobial administration are associated with poor outcomes including higher in-hospital mortality for patients with sepsis. Multiple factors contribute to delays in timely antimicrobial administration including diagnostic errors and health system factors such as high patient volumes and acuity. To further identify modifiable health system factors that may contribute to delays in sepsis care, we assessed the association between patient census in the emergency department (ED) and time to antimicrobial administration in patients with sepsis. Methods We conducted a retrospective cohort study of adults (18 years) diagnosed with sepsis in the ED at one of 19 hospitals in an integrated healthcare system between 2022 and 2024. Patients meeting both Systemic Inflammatory Response Syndrome (SIRS) criteria within 6 hours of ED arrival and Adult Sepsis Event (ASE) criteria who were admitted to the hospital were included. ED census was calculated using the number of patients in the ED at time of arrival and standardized to account for heterogeneity in unit capacity. The primary outcome was time from ED arrival to administration of antimicrobials with a secondary outcome of mortality. Association between variables was assessed using linear mixed effect regression models and survival analysis accounting for correlations within the ED. Results The cohort included 13,066 patients with complete ED census data. Median age was 65 years, 47% were female and 68% were white race. 1922 (14.7%) of the patients died during the hospitalization. The median time to first antimicrobial dose was 3.0 hours (IQR 1.7, 5.2). Every standard deviation increase in standardized ED census was associated with a significant increase in time to first antimicrobial administration of 0.23 hours (14 minutes) (SD = 0.04, p 0.001). Standardized ED census was not significantly associated with in-patient mortality (HR = 1.0, p = 0.81). Conclusion In this cohort of adults presenting to the ED with sepsis, standardized ED census was associated with longer time to initial antimicrobial administration but not in-hospital mortality. These findings suggest additional resources may be needed to support timely antimicrobial administration when ED patient volumes are high. Additional work is needed to understand the relationship between health system strain and mortality in patients with sepsis. This abstract is funded by: None