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Emergency department crowding and sepsis
YAJEM-56847; No of Page 1 American Journal of Emergency Medicine xxx (2017) xxx
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Emergency department crowding and sepsis
Therefore, we think that Gaieski et al. should also evaluate possible association between blood culture contamination and ED overcrowding in patients with severe sepsis. References
We read with great interest the article by Gaieski et al. in the American Journal of Emergency Medicine [1]. The authors investigated the patients with severe sepsis admitted to the hospital from the ED between 2005 and 2010. This retrospective cohort study revelaed that increased ED crowding significantly delays time to initial administration of intravenous fluids and antibiotics and decreases the implementation of protocolized care [1]. Crowded departments are a problem for healthcare systems in many countries and a growing body of evidence shows that ED and intensive care units crowding is adversely affect on clinically important outcomes in patients with sepsis [2,3]. Shin and colleagues have shown that ED crowding had adverse effects on compliance with the resuscitation bundle in the management of severe sepsis or septic shock and was significantly associated with lower compliance with the entire resuscitation bundle [2]. ED crowding was also associated with decreased likelihood of the timely implementation of the bundle elements, including early broad-spectrum antibiotic administration [2]. Yergens and colleagues revealed that increased intensive care unit occupancy was associated with higher in-hospital mortality in patients with sepsis admitted via the ED [3]. They found that intensive care unit occupancy ≥90% at the time of physician assessment in the ED was the most significant risk factor associated with an increased in-hospital mortality for sepsis patients [3]. However, ED overcrowding is not only associated with delays in diagnosis, appropriate management, and patient outcomes but also with blood culture contamination. Lee et al. showed that ED overcrowding was independently associated with contaminated blood cultures [4]. They found that the contamination rate was 1.67% and, coagulase- negative staphylococci was the most common contaminant.
[1] Gaieski DF, Agarwal AK, Mikkelsen ME, Drumheller B, Cham Sante S, Shofer FS, et al. The impact of emergency department crowding on early interventions and mortality in patients with severe sepsis. Am J Emerg Med 2017 Jan 31 (pii: S07356757(17)30081-5). [2] Shin TG, Jo IJ, Choi DJ, Kang MJ, Jeon K, Suh GY, et al. The adverse effect of emergency department crowding on compliance with the resuscitation bundle in the management of severe sepsis and septic shock. Crit Care 2013 Oct 6;17(5):R224. [3] Yergens DW, Ghali WA, Faris PD, Quan H, Jolley RJ, Doig CJ. Assessing the association between occupancy and outcome in critically ill hospitalized patients with sepsis. BMC Emerg Med 2015 Oct 19;15:31. [4] Lee CC, Lee NY, Chuang MC, Chen PL, Chang CM, Ko WC. The impact of overcrowding on the bacterial contamination of blood cultures in the ED. Am J Emerg Med 2012 Jul; 30(6):839–45.
Funda Sungur Biteker MD Yatağan State Hospital, Department of Infectious Diseases and Clinical Microbiology, Turkey Eda Özlek MD Oğuzhan Çelik MD Bülent Özlek MD* Murat Biteker MD Associate Prof Muğla University, Faculty of Medicine, Department of Cardiology, Turkey ⁎Corresponding author at: Mugla Sitki Kocman Universitesi Tip Fakultesi, Orhaniye Mah. Haluk Özsoy Cad, 48000 Muğla, Turkey. E-mail address: [email protected]. 4 June 2017 Available online xxxx
http://dx.doi.org/10.1016/j.ajem.2017.07.061 0735-6757/© 2017 Elsevier Inc. All rights reserved.
Please cite this article as: Biteker FS, et al, , American Journal of Emergency Medicine (2017), http://dx.doi.org/10.1016/j.ajem.2017.07.061
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Emergency department crowding and sepsis
Therefore, we think that Gaieski et al. should also evaluate possible association between blood culture contamination and ED overcrowding in patients with severe sepsis. References
We read with great interest the article by Gaieski et al. in the American Journal of Emergency Medicine [1]. The authors investigated the patients with severe sepsis admitted to the hospital from the ED between 2005 and 2010. This retrospective cohort study revelaed that increased ED crowding significantly delays time to initial administration of intravenous fluids and antibiotics and decreases the implementation of protocolized care [1]. Crowded departments are a problem for healthcare systems in many countries and a growing body of evidence shows that ED and intensive care units crowding is adversely affect on clinically important outcomes in patients with sepsis [2,3]. Shin and colleagues have shown that ED crowding had adverse effects on compliance with the resuscitation bundle in the management of severe sepsis or septic shock and was significantly associated with lower compliance with the entire resuscitation bundle [2]. ED crowding was also associated with decreased likelihood of the timely implementation of the bundle elements, including early broad-spectrum antibiotic administration [2]. Yergens and colleagues revealed that increased intensive care unit occupancy was associated with higher in-hospital mortality in patients with sepsis admitted via the ED [3]. They found that intensive care unit occupancy ≥90% at the time of physician assessment in the ED was the most significant risk factor associated with an increased in-hospital mortality for sepsis patients [3]. However, ED overcrowding is not only associated with delays in diagnosis, appropriate management, and patient outcomes but also with blood culture contamination. Lee et al. showed that ED overcrowding was independently associated with contaminated blood cultures [4]. They found that the contamination rate was 1.67% and, coagulase- negative staphylococci was the most common contaminant.
[1] Gaieski DF, Agarwal AK, Mikkelsen ME, Drumheller B, Cham Sante S, Shofer FS, et al. The impact of emergency department crowding on early interventions and mortality in patients with severe sepsis. Am J Emerg Med 2017 Jan 31 (pii: S07356757(17)30081-5). [2] Shin TG, Jo IJ, Choi DJ, Kang MJ, Jeon K, Suh GY, et al. The adverse effect of emergency department crowding on compliance with the resuscitation bundle in the management of severe sepsis and septic shock. Crit Care 2013 Oct 6;17(5):R224. [3] Yergens DW, Ghali WA, Faris PD, Quan H, Jolley RJ, Doig CJ. Assessing the association between occupancy and outcome in critically ill hospitalized patients with sepsis. BMC Emerg Med 2015 Oct 19;15:31. [4] Lee CC, Lee NY, Chuang MC, Chen PL, Chang CM, Ko WC. The impact of overcrowding on the bacterial contamination of blood cultures in the ED. Am J Emerg Med 2012 Jul; 30(6):839–45.
Funda Sungur Biteker MD Yatağan State Hospital, Department of Infectious Diseases and Clinical Microbiology, Turkey Eda Özlek MD Oğuzhan Çelik MD Bülent Özlek MD* Murat Biteker MD Associate Prof Muğla University, Faculty of Medicine, Department of Cardiology, Turkey ⁎Corresponding author at: Mugla Sitki Kocman Universitesi Tip Fakultesi, Orhaniye Mah. Haluk Özsoy Cad, 48000 Muğla, Turkey. E-mail address: [email protected]. 4 June 2017 Available online xxxx
http://dx.doi.org/10.1016/j.ajem.2017.07.061 0735-6757/© 2017 Elsevier Inc. All rights reserved.
Please cite this article as: Biteker FS, et al, , American Journal of Emergency Medicine (2017), http://dx.doi.org/10.1016/j.ajem.2017.07.061