Keywords
Septic shock
Emergency department
Quality improvement
PDCA
Antibiotics
NEWS2
Submitted : 2026-06-22
Accepted : 2026-07-07
Published : 2026-07-22
Abstract
Background: Sepsis is a life-threatening condition associated with substantial morbidity, mortality, and healthcare utilization. In the emergency department (ED), early recognition and prompt antibiotic administration are essential components of high-quality care. In 2024, compliance with timely antibiotic administration for sepsis in our ED fell below the institutional target, with recurrent delays observed in obstetric and gynecologic (OB-GYN) presentations. Objective: To improve early sepsis recognition and increase the rate of timely antibiotic administration in the ED using a Plan-Do-Check-Act (PDCA) quality improvement framework. Methods: We conducted a single-center quality improvement initiative in the ED of Beijing United Family Hospital. Interventions included implementation of a triage sepsis alert, screening with the National Early Warning Score 2 (NEWS2), a standardized sepsis order set, workflow standardization, targeted staff education on atypical and OB-GYN sepsis presentations, and monthly audit-and-feedback cycles. The primary outcome was the proportion of ED patients with sepsis or septic shock who received antibiotics within the target time window after recognition. Secondary process measures included time from triage to antibiotic order, time from order to administration, and time from triage to first antibiotic dose. Results: Following implementation, timely antibiotic administration improved from 33% at baseline to 100% from August 2024 through January 2025. Although monthly case numbers were small, sustained full compliance across consecutive months suggested improved process reliability. The mean time from triage to antibiotic order was approximately 5 minutes, the mean time from order to administration was approximately 6 minutes, and the mean time from triage to first antibiotic dose was approximately 11 minutes. Conclusion: A PDCA-based sepsis quality improvement initiative was associated with substantial and sustained improvement in timely antibiotic administration in the ED. Standardized recognition processes, clear escalation pathways, and continuous feedback may improve the reliability of sepsis care, including in atypical presentations such as OB-GYN cases.
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