Abstract

Background: In emergency medicine, for sepsis, pain management and many other conditions the right interventions at the right time are essential. Patients with sepsis must be given antibiotics promptly. Likewise, effective pain relief enhances patient comfort and reduces complications. Although ED has quality assurance programs that ensure prompt care, scanty research investigates their efficiency in multi-bedded super specialty centers managing complex cases. These settings have high patient volumes and variable caseloads making it difficult to follow time-sensitive protocols. This study aims at analyzing the effectiveness of our existing QA policy of ED’s in our multi-bedded super specialty centre with a major focus on ensuring the timely administration of antibiotics for septicemia patients. In addition, we shall also assess how efficient the ED is by looking at two main time measures; medical practitioners’ initial assessment time and time from pain recognition to appropriate analgesic administration. We anticipate this will help identify gaps within the QA policy and general practices to enhance faster and better services offered across these critical areas within our emergency department. AIM: Study to evaluate the effectiveness of the existing QA policy within our multibedded super specialty center ED, with a primary focus on ensuring timely antibiotic administration for sepsis patients Analyze the ED’s performance regarding two key time metrics: 1. Initial assessment time by medical practitioners. 2. The time interval for appropriate pain medication administration. Materials and Methods: Prospective cohort study was conducted at Amrita Institute of Medical Sciences and Research Centre Kochi, India for this includes sixty two patients for primary objective. The aim is to evaluate the quality of emergency department (ED) care using direct observation of essential time intervals. Meticulous observation will be employed to collect data from patient encounters in the ED between [11/2023] to [06/2024]. This study aims at capturing and analyzing time intervals like initial assessment, ED arrival to antibiotic administration in sepsis and septic shock cases and ED arrival to analgesic administration. Patients observed would be eligible if they had presented to the ED within that period as per inclusion criteria. Patients who refuse treatment / Patients who are indecisive with regards to their care or family members denying them care will be excluded based on exclusion criteria. Result: Examining ED quality assurance, we found that 85.5% of sepsis cases received antibiotics within the recommended time frame, with mean times of 105.66 minutes for sepsis and 53.03 minutes for septic shock. In pain management, 81.5% of cases received analgesics within guidelines, with mean times of 25.36 minutes for mild pain and 15.69 minutes for severe pain. Initial patient assessments met timeliness standards in 98.3% of cases. Conclusion: The study shows that the Emergency Department (ED) strictly follows clinical guidelines for sepsis, septic shock, as well as pain treatment by presenting high adherence to antibiotic administration, and analgesic delivery. Besides, prompt and adequate initial patient evaluations show the ED’s commitment to the provision of quality healthcare services. These results uncover a strong framework for fostering ongoing improvements which means continuous efforts should be made towards optimizing ED performance to increase better results on patients’ side.

• 1.   Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., Bellomo, R., Bernard, G. R., Chiche, J.-D., Coopersmith, C. M., et al. (2016). The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 315, 801– 810. https://doi.org/10.1001/jama.2016.0287.
• 2.   Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Society of Critical Care Medicine. https://www.sccm.org/ SurvivingSepsisCampaign/Guidelines/AdultPatients.
• 3.   Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, J. W., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., ... Levy, M. (2021). Surviving Sepsis Campaign: International Guidelines for the Management of Sepsis and Septic Shock 2021. Critical Care Medicine, 49(11), 1974-1982. https://doi.org/10.1097/ CCM.0000000000005357.
• 4.   Seymour, Christopher W., et al. “Time to Treatment and Mortality during Mandated Emergency Care for Sepsis.” The New England Journal of Medicine, vol. 376, no. 22, 2017, pp. 2235-2244. https://doi.org/10.1056/ NEJMoa1703058.
• 5.   Gavelli, Francesco, Luigi Mario Castello, and Gian Carlo Avanzi. “Management of Sepsis and Septic Shock in the Emergency Department.” Intern Emerg Med, vol. 16, no. 6, 2021, pp. 1649–1661. https://doi.org/10.1007/s11739- 021-02735-7.
• 6.   Yuzeng, S., & Hui, L. L. (2020). Improving the wait time to triage at the emergency department. BMJ Open Quality, 9(1), e000708. https://doi.org/10.1136/bmjoq-2019-000708.
• 7.   Cetin, M., Kaya, B., Kilic, T. Y., Hanoglu, N. D., Gokhan, S., Eroglu, S. E., Akar, S. N., Cekic, O. G., Polat, D., Ustsoy, E., Cinar, O., & Yilmaz, S. (2021). Pain management practices in the emergency departments in Turkey. Turkish Journal of Emergency Medicine, 21(4), 189-197. https://doi.org/10.4103/2452 2473.329633.

Data Sharing Statement

Funding