Table 2.
Study Outcomes
| Reference | Definition of Time to Antibiotics | Time to Antibiotics | ICU Length of Stay | Hospital Length of Stay | In-hospital Mortality | Other Notable Findings |
|---|---|---|---|---|---|---|
| Sarani et al. 200819 | Time from antibiotic order to first dose of antibiotic administration | Median of 54 minutes (IQR, 40–91 minutes) in MET group vs. 157 minutes (IQR, 113–258 minutes) in non-MET group; p<0.01 | NR | NR | NR | Non-MET group without pharmacist involvement: 15 minutes median time between CPOE and order verification, 82 minutes between order verification and delivery to nursing, and 60 minutes between drug delivery to administration |
| LaRosa et al. 201216 | Time to administration determined by binary assessment of compliance: antibiotics given within 3 hours of ED triage time and within 1 hour for non-ED admission | Antibiotic administration meeting time-based compliance: 91% in sepsis alert group vs. 54% in control; p<0.001 | NR | NR | 3/34 (9%) in sepsis alert group vs. 7/24 (29%) in control; p<0.05 | None |
| Flynn et al. 201414 | Time from sepsis recognition to antibiotic administration (pathogen susceptible) | Median of 0.65 hours in intervention vs. 2.4 hours in control | Median of 8 days (IQR 3–15 days) in intervention vs. 8 days (IQR 2–17 days) in control; p=0.83 | Median of 15 days (IQR 8–44 days) in intervention vs. 12 days (IQR 7–24 days) in control; p=0.14 | 48.9% intervention vs. 54.2% in control; p=0.586 | 77.5% of patients received appropriate antibiotics within 1 hour of sepsis recognition in the intervention group vs. 23.7% in the control group. |
| Beardsley et al. 201612 | Time from rapid response nurse arrival to the bedside and first dose of antibiotic administered | Mean of 53 minutes in Code Sepsis group vs. 396 minutes in historical group | NR | NR | NR | 1) Initiative associated with reduction in institution’s adjusted mortality index for sepsis by 16% 2) Pharmacists ordered antibiotics in 28% of Code Sepsis episodes in which antibiotics were ordered 3) Upon further roll out, mean time from Code Sepsis page to antibiotic delivery (including ordering and pharmacist verification) was 14.1 ± 13.7 minutes |
| Moussavi et al. 201618 | Time from antibiotic order to first documented dose of antibiotic administration | Median 0.61 hours (IQR, 0.37–0.95 hours) in pharmacist group vs. 0.88 hours (IQR, 0.525–1.23) in non-pharmacist group; p=0.001 | Median of 4 days (IQR, 2–11 days) in pharmacist group vs. 3.5 days (IQR, 2–8 days) in non-pharmacist group; p=0.37 | Median of 10.5 days (IQR, 5–16.8 days) in pharmacist group vs. 8.5 days (IQR, 5–15 days) in non-pharmacist group; p=0.437 | 19/92 (21%) in pharmacist group vs. 23/94 (24%) in non-pharmacist group; p=0.534 | 1) ED pharmacist presence improved proportion of patients receiving antibiotics within 3 hours: 100% vs. 95%; p=0.025 2) ED pharmacist presence improved proportion of patients receiving appropriate initial antibiotics: 97% vs. 81%; p=0.0008 |
| Laine et al. 201815 | Time from sepsis bundle order activation to first dose of documented antimicrobial | Median time to first dose of antibiotics was 43 minutes (no comparator group but control group from Flynn et al14 could be extrapolated) | Median of 11 days in pharmacist responder group (no comparator group) | Median of 18 days in pharmacist responder group (no comparator group) | 40/76 (53%) in pharmacist responder group (no comparator group) | 1) 66% of patients had antibiotics ordered at the time of sepsis bundle activation that covered the eventual pathogen identified; following pharmacist intervention this was increased to 80% (p=0.04) 2) Common documented interventions by pharmacist included changing original antimicrobial, adding double coverage for gram-negative pathogens, and adding empiric antifungals |
| Chanas et al. 201913 | Time from best practice alert trigger to administration of first new antibiotic | Median 4.2 hours in BPA group vs. 7.4 hours pre-BPA implementation; p=0.057) | Median of 5 days (IQR, 2–12 days) (no comparator group) | Median of 15 days (IQR, 8–32 days) (no comparator group) | 24/97 (25%) (no comparator group) | 1) Time to antibiotics significantly shorter when pharmacist responded to the bedside: 1.2 vs. 4.2 hours; p=0.046 2) When a pharmacist responded to the bedside, more patients had antibiotics started within 1 hour (36% vs. 14%; p=0.021) and 3 hours (60% vs. 34%; p=0.031) 3) Pharmacists responded to 67% of alerts, which could represent staffing limitations |
| MacMillan et al. 201917 | Time to administration defined per the 2012 Surviving Sepsis Campaign Guidelines | Antibiotic administration within 3 hours: 59.1% post-quality improvement initiative vs. 51.4% before; p=0.342 | Mean 5.6 ± 5.3 days post-quality improvement initiative vs. 5.9 ± 7.6 days before; p=0.808 | Mean 9.9 ± 8.0 days post-quality improvement initiative vs. 10.0 ± 10.3 days before; p=0.121 | 24/88 (27.3%) post-quality improvement initiative vs. 23/72 (31.9%) before; p=0.518 | None |
| Yarbrough et al. 201921 | Time to administration defined per SEP-1 criteria | Median of 46 minutes (IQR, 31–61.5 minutes) in pharmacist responder group vs. 68 minutes (IQR, 49–96 minutes) in the comparator group; p=0.009 | NR | NR | NR | Pharmacist response was associated with greater proportion of patients receiving antibiotics within 1 hour: 73% vs. 33%; p=0.002 |
| Tarabichi et al. 202220 | Time to first dose of antibiotics from arrival in ED | Median of 2.3 hours (IQR, 1.4–4.7 hours) in intervention vs. 3.0 hours (IQR, 1.6–5.5 hours) in control; p=0.039 | Median of 3.6 days (IQR, 2.0–5.4 days) in intervention vs. 3.4 days (IQR, 2.0–6.0 days) in control; p=0.937 | Median of 3.2 days (IQR, 1.1–6.2 days) in intervention vs. 4.0 days (1.4–7.0 days) in control; p=0.124 | 13/285 (4.6%) in intervention vs. 25/313 (8.0%) in control; p=0.086 | 1) Patients with intervention had greater days alive and out of hospital vs. control: median 24.1 vs. 22.5; p=0.011 2) Patients with intervention demonstrated shorter median time from alert to antibiotic ordering of 0.6 hours (IQR, 0.0–2.6 hours) vs. 1.4 hours (IQR, 0.2–3.9 hours; p=0.043) and shorter median time from antibiotic order placement to administration of 0.4 hours (IQR, 0.2–0.9 hours) vs 0.7 hours (IQR, 0.3–1.4 hours; p=0.001) 3) Randomized nature ultimately ceased to allow pharmacist notification as new standard of care |
BPA = best-practice advisory; CPOE = computerized physician order entry; ED = emergency department; IQR = interquartile range; MET = medical emergency team; NR = not reported; SEP-1 = Centers for Medicare and Medicaid Services Severe Sepsis/Septic Shock.