Sepsis call emergency department pharmacist service: a single healthcare network cohort study

Background

Sepsis and septic shock are common emergency department (ED) presentations, with current guidelines recommending early administration of antibiotics to reduce mortality.

Aim

Sepsis calls with pharmacist attendance have been introduced at two EDs, and the aim of this study was to evaluate the impact of this service on outcomes of all septic patients.

Method

At a multisite, single healthcare network, located in Victoria, Australia, emergency medicine pharmacists were trained in assisting medical staff in antibiotic selection, dosing, and delivering antibiotics directly to nursing staff. The sepsis call service was introduced in May 2022 at one site and in March 2023 at another site, with time to first antibiotic administration, morbidity, and mortality being compared to the outcomes of patients from the same EDs from January–April 2022 (group 1). Post the sepsis call introduction, two cohorts were compared: sepsis call attended patients without a pharmacist (group 2) and with a pharmacist (group 3). This project was exempt due to the local policy requirements that constitute research by the Monash Health Human Research Ethics Committee (Reference no: RES-23-0000-237Q). The justification for this ethics exemption was as follows: the study was retrospective, included privacy protections for patients' data, and presented no increased risk to patient care.

Results

The study included 201 patients, with time to first antibiotic administration on average 302.0 min in group 1, 201.3 min (p = 0.007) in group 2, and 89.8 min (p < 0.001) in group 3. Mortality (p = 0.306), rates of acute kidney injury (p = 0.111), intensive care unit (ICU) admission (p = 0.002), and need for dialysis (p = 0.497) were all reduced in group 3. Adherence to antibiotic guidelines was increased in group 3 (p < 0.001).

Conclusion

Emergency medicine pharmacist contribution led to reduced time to first antibiotic, an improved adherence to antibiotic guidelines, and positive trends in secondary clinical outcomes. Further research is required to determine the significance of improvements in mortality, intensive care unit admissions, and renal impairment.