title: Use of a protocolized approach to the management of sepsis can improve time to first dose of antibiotics.
abstract: OBJECTIVE
  The Surviving Sepsis Guidelines established recommendations for early recognition and rapid treatment of patients with sepsis. Recognizing systemic difficulties that delayed the application of early goal-directed therapy, the Emergency Department and Critical Care leadership instituted a sepsis protocol to identify patients with sepsis and expedite antibiotic delivery. We aimed to determine if the sepsis protocol improved the time to first dose of antibiotics in patients diagnosed with sepsis.
  
  
  METHODS
  We performed a retrospective chart review of patients with sepsis comparing the time from antibiotic order placement to the first dose of antibiotic therapy over a 3-year period. Patients who received vancomycin and ciprofloxacin underwent additional subgroup analysis, as these antibiotics were made available by protocol for use without infectious disease consultation.
  
  
  RESULTS
  The average time to first dose of antibiotics for the presepsis protocol group was 160 minutes, and the average time for the sepsis protocol group was 99 minutes. Fifty-eight patients received vancomycin, and 30 received ciprofloxacin, with a decrease in time of 65 minutes and 41 minutes, respectively.
  
  
  CONCLUSIONS
  Initiation of a sepsis protocol, which emphasizes early goal-directed therapy, can improve time to administration of first dose of antibiotics.
authors.affiliation: Madigan Army Medical Center, Tacoma, WA, USA.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Tipler
authors.forename: Jeremy
authors.initials: J
authors.lastname: Pamplin
authors.forename: Vincent
authors.initials: V
authors.lastname: Mysliwiec
authors.forename: David
authors.initials: D
authors.lastname: Anderson
authors.forename: Cristin A
authors.initials: CA
authors.lastname: Mount
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D006801:Humans; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents