G461(P)\u2005Antibiotic therapy in high risk of sepsis emergency department patients – the debate about who should deliver the care

Abstract

Aims The importance of early recognition and antimicrobial intervention in paediatric patients developing clinical evidence of sepsis is now well-established. In centres with patients under specialist teams there is a debate about how initial treatment should be delivered and with ever-increasing pressure on emergency services this grows more pertinent. The aim of this study was to review the antibiotic administration for children presenting to a specialist paediatric emergency department with one or more age-appropriate observational parameters matching SIRS criteria and an additional risk factor for sepsis, defined as; current oncological chemotherapy, aplastic anaemia, post-stem cell/bone marrow therapy, or home parental nutrition via a central venous catheter. Following surprising initial findings this study was extended to review the impact of initial specialist team intervention on this protocolised ‘golden hour’ target. Method A search of all the patients presenting to a specialist paediatric emergency department over a 1\u2009year period between 2017–2018 with one or more age-appropriate initial observational parameters matching SIRS criteria was performed. The search was performed using PatientFirst software and identified a cohort of 945 patients. This population was searched for criteria identifying them as meeting the high-risk criteria above. This yielded a population of 59 patients (n=59). The scanned and physical hospital records for this population were reviewed and the results for antibiotic administration times compared to the grade and team reviewing the patient. The data has been anonymised and there were no adverse incidents identified. Results The mean time from booking to triage was 5.14\u2009min (range 0–17). The mean time from booking to review by a clinician was 25.7\u2009min (range 1–155). For emergency department staff providing the initial assessment the mean time was 18.7\u2009min (range 1–72) compared to 44.6 (range 11–155) if the initial review was from a specialist team. 58% of patients received antibiotics within 60\u2009min of arrival. Conclusion This data adds weight to the debate about the protocolised treatment of high risk of sepsis patients by suggesting an improved performance when emergency staff provides the initial assessment and care.