Earlier initiation of antibiotic treatment for severe infections after interventions to improve the organization and specific guidelines in the emergency department

Objective: To examine whether combined interventions improve the timely adm inistration of antibiotic therapy and acquisition of material for culture f rom patients admitted to the emergency department with a serious infectious disease. Methods: Guidelines and educational programs were developed to facilitate t imely antibiotic administration: guidelines on handling patients with serio us infections and on ordering immediate treatment, guidelines on obtaining culture samples, lectures to medical and nursing staff, improvement of avai lability of antibiotics in the emergency department, and removal of financi al restraints on stocking and ordering of antibiotics. Fifty consecutive pa tients were evaluated after this series of interventions and compared with the results in 50 patients evaluated before the interventions. The interval from presentation to the emergency department until the administration of antibiotics, number of samples taken for microbiological investigations, an d number of patients receiving a first dose of antibiotic at routinely sche duled drug distribution rounds were evaluated. Results: The median time to the initial dose of antibiotics administered de creased from 5.0 hours to 3.2 hours (P = .04). The number of blood cultures obtained did not change. The percentage of sputum cultures obtained increa sed from 28% to 50%, and the percentage of urine cultures obtained increase d from 50% to 100%. The percentage of patients whose first dose of antibiot ic was delayed until a routinely scheduled drug distribution round decrease d from 54% to 32% (P = .03). Conclusions: Combined interventions to expedite diagnostic and therapeutic actions through directed clinical practice guidelines and organizational me asures are successful. This may lead to a substantial quality improvement i n the process of care.