title: Sepsis Alert - a triage model that reduces time to antibiotics and length of hospital stay.
abstract: OBJECTIVE
  To study if a modified triage system at an Emergency Department (ED) combined with educational efforts resulted in reduced time to antibiotics and decreased length of hospital stay (LOS) for patients with severe infection.
  
  
  METHODS
  A retrospective, observational study comparing patients before and after the start of a new triage model at the ED of a University Hospital. After the implementation of the model, patients with fever and abnormal vital signs were triaged into a designated sepsis line (Sepsis Alert) for rapid evaluation by the attending physician supported by a infectious diseases (IDs) specialist. Also, all ED staff participated in a designated sepsis education before Sepsis Alert was introduced. Medical records were evaluated for patients during a 3-month period after the triage system was started in 2012, and also during the corresponding months in 2010 and 2014.
  
  
  RESULTS
  A total of 1837 patients presented with abnormal vital signs. Of these, 221 patients presented with fever and thus at risk of having severe sepsis. Among patients triaged according to the new model, median time to antibiotics was 58.5 at startup and 24.5 minutes at follow-up two years later. This was significantly less than for patients treated before the new model, 190 minutes. Also, median LOS was significantly decreased after introduction of the new triage model, from nine to seven days.
  
  
  CONCLUSIONS
  A triage model at the ED with special attention to severe sepsis patients, led to sustained improvements of time to antibiotic treatment and LOS.
authors.affiliation: a Infectious Disease Unit.
authors.forename: Mari
authors.initials: M
authors.lastname: Rosenqvist
authors.affiliation: a Infectious Disease Unit.
authors.forename: Emma
authors.initials: E
authors.lastname: Fagerstrand
authors.affiliation: a Infectious Disease Unit.
authors.forename: Peter
authors.initials: P
authors.lastname: Lanbeck
authors.affiliation: b Department of Internal Medicine , Skåne University Hospital , Malmö , Sweden , Department of Clinical Sciences Malmö , Lund University , Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Melander
authors.affiliation: c Infectious Disease Unit, Skåne University Hospital , Lund , Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Åkesson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019090:Case Management / Q000458:organization & administration*; D004636:Emergency Service, Hospital; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy*; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Emergency Department; Sepsis; length of hospital stay; severe sepsis; time to antibiotics