Association of Sepsis Diagnosis at Daytime and on Weekdays with Compliance with the 3-Hour Sepsis Treatment Bundles. A Multicenter Cohort Study

Abstract

Rationale: Compliance with sepsis bundles is associated with better outcomes, but information to support structural actions that might improve compliance is scarce. Few studies have evaluated bundle compliance in different time periods, with conflicting results.Objective: To evaluate the association of sepsis identification during the daytime versus during the nighttime and on weekdays versus on weekends with 3-hour sepsis treatment bundles compliance.Methods: Observational, multicenter study including septic patients admitted between 2010 and 2017 to 10 hospitals in Brazil. Our exposures of interest were Daytime (07:00

Relationship Between Nighttime Emergency Department Admission and Adherence to a Sepsis Treatment Bundle

“…reported that patients treated for sepsis during the daytime (de ned based on the sepsis identi cation time) received more frequent lactate measurements, earlier antibiotic administration, and increased compliance with the complete 3-h sepsis bundle [17]. They hypothesized that a higher turnover rate of staff during night shifts, including displaced staff from other areas to cover the shifts, could affect the association between daytime ED presentation and better sepsis bundle compliance [17]. In our clinical setting, most of the nursing staff working in emergency departments are subjected to a 'three-shift rotation schedule' (day, evening, and night shifts), and staff members are rarely displaced from other areas to cover night shifts.…”

“…reported that patients treated for sepsis during the daytime (de ned based on the sepsis identi cation time) received more frequent lactate measurements, earlier antibiotic administration, and increased compliance with the complete 3-h sepsis bundle [17]. They hypothesized that a higher turnover rate of staff during night shifts, including displaced staff from other areas to cover the shifts, could affect the association between daytime ED presentation and better sepsis bundle compliance [17].…”

“…The outcome measure was de ned as the completion of the SSC 3-h treatment bundle, which comprises lactate measurements, blood draws for culturing prior to antibiotic administration, prompt administration of broad-spectrum antibiotics, and appropriate uid challenge for patients with a mean arterial pressure < 65 mmHg and/or a serum lactate concentration of 4 mmol/L or greater [17]. The compliance rate with the 3-hour sepsis bundle was calculated according to the time of arrival in the ED.…”

“…To test the main hypothesis, subjects were classi ed according to the time of the ED visit or the rate of compliance with the complete 3-h bundle. [17,22] Statistical analyses were performed using SAS, version 9.2 (SAS Institute Inc., Cary, NC) and MedCalc Statistical Software version 16.4.3 (MedCalc Software bvba, Ostend, Belgium). P-values < 0.05 were considered statistically signi cant.…”

“…Considering these factors, whether nighttime admission can adversely affect timely sepsis bundle management is debatable. Few studies have evaluated the association between timely bundle management and the time of ED visits in patients with sepsis, and con icting results have been reported [17,18]. Therefore, this large, multicenter study was conducted to investigate the rate of compliance with the SSC 3-h bundle for nighttime and daytime ED admissions and to investigate the clinical impacts of non-compliance on mortality in patients with septic shock.…”