Background Sepsis is a serious medical condition that can lead to organ dysfunction and death. Research shows that each hour delay in antibiotic administration increases mortality. The Surviving Sepsis Campaign Bundles created standards to assist in the timely treatment of patients with suspected sepsis to improve outcomes and reduce mortality. Objective This article determines if the use of an electronic physician order-set decreases time to antibiotic ordering for patients with sepsis in the emergency department (ED). Methods A retrospective chart review was performed on adult patients who presented to the ED of four community hospitals from May to July 2016. Patients with severe sepsis and/or septic shock were included. Primary outcome was the difference in time to antibiotic ordering in patients whose physicians utilized the order-set versus those whose physicians did not. Secondary outcomes included differences in time to antibiotic administration, time to lactate test, hospital length of stay, and posthospitalization disposition. The institution's Quality Improvement Committee approved the project. Results Forty-five of 123 patients (36.6%) with sepsis had physicians who used the order-set. Order-set utilization reduced the mean time to ordering antibiotics by 20 minutes (99 minutes, 95% confidence interval [CI]: 69–128 vs. 119 minutes, 95% CI: 91–147), but this finding was not statistically significant. Mean time to antibiotic administration (145 minutes, 95% CI: 108–181 vs. 182 minutes, 95% CI: 125–239) and median time to lactate tests (12 minutes, 95% CI: 0–20 vs. 19 minutes, 95% CI: 8–34), although in the direction of the hypotheses, were not significantly different. Conclusion Utilization of the order-set was associated with a potentially clinically significant, but not statistically significant, reduced time to antibiotic ordering in patients with sepsis. Electronic order-sets are a promising tool to assist hospitals with meeting the Centers for Medicare and Medicaid Services core measure.

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To the Editor: I would like to thank Naughton and colleagues for their insightful article, "Expanding Dress Code Requirements in the Doctor of Pharmacy Program." 1 Professionalism is extremely important in many practice settings, but it is particularly vital to health care professionals because it impacts both patient and health care colleague perceptions. Numerous schools of pharmacy have adopted varying levels of mandatory professional dress codes, including for didactic lectures. The article by Naughton and colleagues thoughtfully discusses in detail both the arguments for and against requiring professional dress codes across all PharmD programs. However, the authors took liberties to extrapolate conclusions beyond the published data, which do not correlate to the success of pharmacy students or their professional development. Additionally, there are many other aspects apart from attire that contribute to professionalism that are not enhanced by dress codes. Professionalism is a multifaceted skill embodying the attributes, behaviors, commitments, values, and goals that characterize a profession, while attire is merely a symbol of professionalism. 1,2 A recent systematic review by Petrilli and colleagues examined patients' perceptions of physicians based on their dress. 3 The review concluded that patients' perceptions of physicians were multifactorial and varied based on age, population, geographic location, and context. 3 While patients initially preferred professionally dressed physicians in pictures, they did not take preference after having actual physician encounters. 3 Petrilli and colleagues noted, "Sartorial style is skin-deep and not a surrogate for medical knowledge or competence; the best-dressed physicians are likely to fare poorly in the eyes of patients if medical expertise is perceived absent." 3 The same may be inferred to the pharmacy profession; it is intellect, effective communication, and professional behavior that is most important for patient perceptions and preferences of health care providers. Many schools of pharmacy around the country require professional dress attire for students in experiential