Impact of emergency room occupancy on the timing of antibiotic administration in patients with septic shock who visited the emergency room

Objective@#The emergency department (ED) serves as the initial point of contact for many sepsis patients, but crowding can affect the timely delivery of essential interventions, such as antibiotics. This paper explores the relationship between antibiotics administration and ED crowding in the context of sepsis management. @*Methods@#This single-center study at a tertiary care hospital included adult patients aged 18 and above who visited the emergency department from January 2018 to December 2022. Patients showing signs of septic shock upon arrival were selected as the study population. This study examined factors such as emergency department occupancy, antibiotic administration time, and their correlation with timely antibiotic treatment. @*Results@#This study of 839 adult patients with septic shock found a weak correlation (P=0.107) between the time to antibiotic administration and department occupancy. Delayed antibiotic administration was observed when the occupancy exceeded 100%. On the other hand, there was no significant correlation between antibiotic administration within one hour and department occupancy. @*Conclusion@#Various factors, such as ED bed occupancy, medical staffing, resource allocation, and patient acuity, must be considered when comprehensively evaluating the impact of ED overcrowding on treating septic shock and other conditions.

Appropriateness of Korean Triage and Acuity Scale-based triage system for dizziness without neurologic symptoms

Objective@#This study aimed to identify the appropriateness of the Korean Triage and Acuity Scale (KTAS) for dizziness without neurological symptoms, which was level 3. @*Methods@#Using the registry of the National Emergency Department Information System (NEDIS), data regarding consecutive emergency patients from January 2016 to July 2018, who were aged 15 years and older, were reviewed retrospectively. The data were classified using KTAS and Dizziness KTAS level 3 were compared with non-dizziness KTAS level 3 including age, total admission rate, intensive care unit (ICU) admission rate, discharge rate, hospital cost, and length of stay in the emergency department (length of stay [LOS]). @*Results@#Of the 76,153 emergency patients, 345 (0.5%) had a KTAS level 1, 4,593 (6.0%) had a KTAS level 2, 21,561 (28.3%) had a KTAS level 3, 45,390 (59.6%) had a KTAS level 4, and 4,264 (5.6%) had a KTAS level 5. As the patient’s triage score decreased, the total admission rate, ICU admission rate, hospital cost, and LOS decreased. Patients discharged to home also had the same result. Dizziness KTAS level 3 had a significantly lower rate of total admission (23% vs. 56.2%, P<0.001) and ICU admission (0.9% vs. 6.2%, P<0.001) compared with non-dizziness KTAS level 3. On the other hand, the hospital cost and LOS were higher when patients were discharged to their home. The predictors of the admission rate of dizziness KTAS level 3 were the transportation method using a private ambulance service and older age, but older age was only slightly associated. @*Conclusion@#This study showed that KTAS level 3 for dizziness needs to be adjusted because of lower severity than other level 3. Old age and the transportation method should be considered factors.