Effect of Out-Of-Hour Admission on Fluid Treatment of Emergency Department Patients with Suspected Infection; a Multicenter Post-Hoc Analysis
Archives of Academic Emergency Medicine,
Vol. 11 No. 1 (2023),
15 November 2022
,
Page e21
https://doi.org/10.22037/aaem.v11i1.1839
Abstract
Introduction: Sepsis is a life-threatening and common cause of Emergency department (ED) referrals. Out-of-hour staffing is limited in ED, which may potentially affect fluid administration. This study aimed to investigate fluid volume variation in out-of-hour vs. routine-hour admissions.
Methods: The present study is a post-hoc analysis of a multicentre, prospective, observational study investigating fluid administration in ED patients with suspected infection, from Jan 20th - March 2nd, 2020. Patient groups were “routine-hours” (RH): weekdays 07:00-18:59 or “out-of-hours” (OOH): weekdays 19:00-06:59 or Friday 19:00-Monday 06:59. Primary outcome was 24-hour total fluid volumes (oral + intravenous (IV)). Secondary outcomes were total fluids 0-6 hours, oral fluids 0-6 and 0-24 hours, and IV fluids 0-6 and 0-24 hours. Linear regression adjusted for site and illness severity was used.
Results: 734 patients had suspected infection; 449 were admitted during RH and 287 during OOH. Mean (95% CI) total 24-hour fluid volumes were equal in simple infection and sepsis regardless of admission time: Simple infection RH: 3640 (3410 - 3871) ml and OOH: 3681 (3451 - 3913) ml. Sepsis RH: 3671 (3443;3898) ml and OOH: 3896 (3542;4250) ml. Oral fluids 0-6h were reduced in simple infection and sepsis among OOH vs. RH. Sepsis patients received more 0-6-hour IV fluid when admitted OOH vs. RH. There were no associations between admission time and 0-24-hour oral or IV volumes in simple infection or sepsis.
Conclusion: Admission time did not have an association with 24-hour total fluid volumes. Sepsis patients admitted during OOH received more 0-6-hour IV fluids than RH patients, and simple infection and sepsis patients received less oral fluid in 0-6 hours if admitted during OOH vs. RH.
- Emergency service, hospital
- fluid therapy
- sepsis
- infections
- time factors
- periodicity
How to Cite
References
Henriksen DP, Laursen CB, Jensen TG, Hallas J, Pedersen C, Lassen AT. Incidence rate of community-acquired sepsis among hospitalized acute medical patients-a population-based survey. Crit Care Med. 2015;43(1):13-21.
Jessen MK, Andersen LW, Thomsen MH, Jensen ME, Kirk ME, Kildegaard S, et al. Twenty-four-hour fluid administration in emergency department patients with suspected infection: A multicenter, prospective, observational study. Acta Anaesthesiol Scand. 2021;65(8):1122-42.
Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200-11.
Levy MM, Rhodes A, Phillips GS, Townsend SR, Schorr CA, Beale R, et al. Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study. Crit Care Med. 2015;43(1):3-12.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303-10.
Kumar G, Kumar N, Taneja A, Kaleekal T, Tarima S, McGinley E, et al. Nationwide trends of severe sepsis in the 21st century (2000-2007). Chest. 2011;140(5):1223-31.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-77.
Arnold RC, Sherwin R, Shapiro NI, O'Connor JL, Glaspey L, Singh S, et al. Multicenter observational study of the development of progressive organ dysfunction and therapeutic interventions in normotensive sepsis patients in the emergency department. Acad Emerg Med. 2013;20(5):433-40.
Capp R, Horton CL, Takhar SS, Ginde AA, Peak DA, Zane R, et al. Predictors of patients who present to the emergency department with sepsis and progress to septic shock between 4 and 48 hours of emergency department arrival. Crit Care Med. 2015;43(5):983-8.
Glickman SW, Cairns CB, Otero RM, Woods CW, Tsalik EL, Langley RJ, et al. Disease progression in hemodynamically stable patients presenting to the emergency department with sepsis. Acad Emerg Med. 2010;17(4):383-90.
Jessen MK, Mackenhauer J, Hvass AM, Heide-Jorgensen U, Christiansen CF, Kirkegaard H. Predictors of intensive care unit transfer or death in emergency department patients with suspected infection. Eur J Emerg Med. 2015;22(3):176-80.
Vincent JL, Jones G, David S, Olariu E, Cadwell KK. Frequency and mortality of septic shock in Europe and North America: a systematic review and meta-analysis. Crit Care. 2019;23(1):196.
Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021;49(11):e1063-e143.
Keijzers G, Macdonald SPJ, Udy AA, Arendts G, Bailey M, Bellomo R, et al. The Australasian Resuscitation In Sepsis Evaluation: Fluids or vasopressors in emergency department sepsis (ARISE FLUIDS), a multi-centre observational study describing current practice in Australia and New Zealand. EMA - Emerg Med Australas. 2020;32(4):586-98.
Marik PE, Linde-Zwirble WT, Bittner EA, Sahatjian J, Hansell D. Fluid administration in severe sepsis and septic shock, patterns and outcomes: an analysis of a large national database. Intensive Care Med. 2017;43(5):625-32.
Hjortrup PB, Haase N, Wetterslev J, Perner A. Associations of Hospital and Patient Characteristics with Fluid Resuscitation Volumes in Patients with Severe Sepsis: Post Hoc Analyses of Data from a Multicentre Randomised Clinical Trial. PLoS One. 2016;11(5):e0155767.
Moellekaer A, Duvald I, Obel B, Madsen B, Eskildsen J, Kirkegaard H. The organization of Danish emergency departments. Eur J Emerg Med. 2019;26(4):295-300.
Loots FJ, Smits M, van Steensel C, Giesen P, Hopstaken RM, van Zanten ARH. Management of sepsis in out-of-hours primary care: a retrospective study of patients admitted to the intensive care unit. BMJ Open. 2018;8(9):e022832.
Vest-Hansen B, Riis AH, Sørensen HT, Christiansen CF. Out-of-hours and weekend admissions to Danish medical departments: admission rates and 30-day mortality for 20 common medical conditions. BMJ Open. 2015;5(3):e006731.
Duvald I, Moellekaer A, Boysen MA, Vest-Hansen B. Linking the severity of illness and the weekend effect: a cohort study examining emergency department visits. Scand J Trauma Resusc Emerg Med. 2018;26(1):72.
Aylin P, Yunus A, Bottle A, Majeed A, Bell D. Weekend mortality for emergency admissions. A large, multicentre study. Qual Saf Health Care. 2010;19(3):213-7.
Barba R, Losa JE, Velasco M, Guijarro C, García de Casasola G, Zapatero A. Mortality among adult patients admitted to the hospital on weekends. Eur J Intern Med. 2006;17(5):322-4.
Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med. 2001;345(9):663-8.
Sharp AL, Choi H, Hayward RA. Don't get sick on the weekend: an evaluation of the weekend effect on mortality for patients visiting US EDs. Am J Emerg Med. 2013;31(5):835-7.
Cram P, Hillis SL, Barnett M, Rosenthal GE. Effects of weekend admission and hospital teaching status on in-hospital mortality. Am J Med. 2004;117(3):151-7.
Bernet S, Gut L, Baechli C, Koch D, Wagner U, Mueller B, et al. Association of weekend admission and clinical outcomes in hospitalized patients with sepsis: An observational study. Medicine (Baltimore). 2020;99(26):e20842.
Bernet S, Gut L, Baechli C, Koch D, Wagner U, Mueller B, et al. Association of weekend admission and clinical outcomes in hospitalized patients with sepsis: An observational study. Medicine. 2020;99(26):e20842.
Powell ES, Khare RK, Courtney DM, Feinglass J. The weekend effect for patients with sepsis presenting to the emergency department. J Emerg Med. 2013;45(5):641-8.
Shih YN, Chen YT, Shih CJ, Ou SM, Hsu YT, Chen RC, et al. Association of weekend effect with early mortality in severe sepsis patients over time. J Infect. 2017;74(4):345-51.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama. 2016;315(8):801-10.
Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama. 2016;315(8):762-74.
You JS, Park YS, Chung SP, Lee HS, Jeon S, Kim WY, et al. Relationship between time of emergency department admission and adherence to the Surviving Sepsis Campaign bundle in patients with septic shock. Crit Care. 2022;26(1):43.
Ranzani OT, Monteiro MB, Besen B, Azevedo LCP. Association of Sepsis Diagnosis at Daytime and on Weekdays with Compliance with the 3-Hour Sepsis Treatment Bundles. A Multicenter Cohort Study. Ann Am Thorac Soc. 2020;17(8):980-7.
Kabil G, Frost SA, McNally S, Hatcher D, Saavedra A, Suster CJE, et al. Identifying factors associated with intravenous fluid administration in patients with sepsis presenting to the emergency department: a retrospective cohort study. BMC Emerg Med. 2022;22(1):98.
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3):486-552.
Byrne L, Obonyo NG, Diab SD, Dunster KR, Passmore MR, Boon AC, et al. Unintended Consequences: Fluid Resuscitation Worsens Shock in an Ovine Model of Endotoxemia. Am J Respir Crit Care Med. 2018;198(8):1043-54.
Maggs F, Mallet M. Mortality in out-of-hours emergency medical admissions--more than just a weekend effect. J R Coll Physicians Edinb. 2010;40(2):115-8.
Khanna R, Wachsberg K, Marouni A, Feinglass J, Williams MV, Wayne DB. The association between night or weekend admission and hospitalization-relevant patient outcomes. J Hosp Med. 2011;6(1):10-4.
- Abstract Viewed: 223 times
- pdf Downloaded: 566 times