2026 Eastern States Conference

Title: 
Effect of emergency department stay on second dose antibiotic administration delays   
 
Authors: 
Trevor Shaffer, PharmD, Temeka D. Lewis-Wolfson, PharmD, BCPS, BCCCP, Marcia Brackbill, PharmD, BCPS 
 
Learning Objective: 
Attendees will be able to explain the variables that affect antibiotic administration delays and sepsis outcomes. 
 
Background/Objective: 
Timely antibiotics are key in sepsis management. This study assesses whether emergency department length of stay contributes to delays in second dose antibiotic administration among sepsis patients admitted to the intensive care unit (ICU). 
 
Methods: 
A retrospective chart review was conducted including patients aged ≥ 18 years admitted to the ICU with a documented sepsis diagnosis between December 1, 2023, to November 30, 2025. Exclusions were death or comfort care within 24 hours of ICU admission, transfer from an inpatient unit or outside hospital, received fewer than two antibiotic doses, or first antibiotic dose administered more than 3 hours after emergency department (ED) arrival. The primary endpoint was the proportion of patients who experienced a delayed second antibiotic dose. Patients were stratified by ED length of stay (LOS) into two groups: <5 hours or ≥ 5 hours. Secondary outcomes included time intervals from ED arrival to antibiotic order entry, order entry to verification, and verification to administration. Additional secondary outcomes included ICU and hospital LOS, in-hospital mortality, incidence and duration of mechanical ventilation (MV), and initial antibiotic coverage. 
 
Results: 
A total of 69 patient encounters met inclusion criteria, with 30 patients in the < 5-hour group and 39 patients in the ≥ 5-hour group. A total of 16 (53%) of the < 5-hour group experienced a dose delay compared to 12 (31%) of the ≥ 5-hour group (p = 0.058). There were no significant findings for any of the secondary outcomes. 
 
Conclusion:  
In this study, no association was identified between ED LOS and second antibiotic dose delays. Given the limited sample size, additional studies with larger patient populations are warranted to further evaluate the impact of transitions of care on timely antibiotic administration in sepsis.  
 
Self-Assessment Question: 
True or False – Patients who experience an extended ED LOS are more likely to experience delayed antibiotic administration.