title: Predictors for Delayed Emergency Department Care in Medical Patients with Acute Infections - An International Prospective Observational Study.
abstract: In overcrowded emergency department (ED) care, short time to start effective antibiotic treatment has been evidenced to improve infection-related clinical outcomes. Our objective was to study factors associated with delays in initial ED care within an international prospective medical ED patient population presenting with acute infections.
  
  
  
  We report data from an international prospective observational cohort study including patients with a main diagnosis of infection from three tertiary care hospitals in Switzerland, France and the United States (US). We studied predictors for delays in starting antibiotic treatment by using multivariate regression analyses.
  
  
  
  Overall, 544 medical ED patients with a main diagnosis of acute infection and antibiotic treatment were included, mainly pneumonia (n = 218; 40.1%), urinary tract (n = 141; 25.9%), and gastrointestinal infections (n = 58; 10.7%). The overall median time to start antibiotic therapy was 214 minutes (95% CI: 199, 228), with a median length of ED stay (ED LOS) of 322 minutes (95% CI: 308, 335). We found large variations of time to start antibiotic treatment depending on hospital centre and type of infection. The diagnosis of a gastrointestinal infection was the most significant predictor for delay in antibiotic treatment (+119 minutes compared to patients with pneumonia; 95% CI: 58, 181; p<0.001).
  
  
  
  We found high variations in hospital ED performance in regard to start antibiotic treatment. The implementation of measures to reduce treatment times has the potential to improve patient care.
authors.affiliation: Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Alexander
authors.identifier: 0000-0002-7549-5648
authors.initials: A
authors.lastname: Kutz
authors.affiliation: Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Jonas
authors.initials: J
authors.lastname: Florin
authors.affiliation: Emergency department, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.|Sorbonne Universités UPMC-Univ Paris06, UMRS INSERM 1166, IHUC ICAN, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Hausfater
authors.affiliation: Morton Plant Hospital, Clearwater, FL, United States of America.
authors.forename: Devendra
authors.initials: D
authors.lastname: Amin
authors.affiliation: Morton Plant Hospital, Clearwater, FL, United States of America.
authors.forename: Adina
authors.initials: A
authors.lastname: Amin
authors.affiliation: Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Haubitz
authors.affiliation: Department of Clinical Nursing Science, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Conca
authors.affiliation: Department of Clinical Nursing Science, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Reutlinger
authors.affiliation: Emergency department, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Canavaggio
authors.affiliation: Emergency department, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Sauvin
authors.affiliation: Biochemistry Department, Hôpital Pitié-Salpêtrière and Univ-Paris Descartes, Paris, France.
authors.forename: Maguy
authors.initials: M
authors.lastname: Bernard
authors.affiliation: Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Huber
authors.affiliation: Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Mueller
authors.affiliation: Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
mesh_terms: D000208:Acute Disease; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003141:Communicable Diseases / Q000188:drug therapy*; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents