Issue: 2010 > March > original article

Reduction of the door-to-needle time for administration of antibiotics in patients with a severe infection: a tailored intervention project

C.F.J. van Tuijn, J.S. Luitse, M. van der Valk, S. van Wissen, M. Prins, R. Rosmulder, S.E. Geerlings


Background: Door-to-needle time (DNT), defined as the
time between arrival at the emergency department (ED)
and intravenous (iv) antibiotic administration is of crucial
importance in the treatment of patients suffering from
serious infections. The aim of this project was to reduce
the DNT for patients with a serious infection as primary
outcome parameter. Methods: All adult patients arriving at the ED with a suspected infection for whom admission and iv antibiotics were indicated were included. Results: Firstly, baseline DNT was measured and potential delaying factors were identified. Subsequently, five tailored interventions were implemented at regular intervals and their effects on the DNT were analysed. The interventions were: 1) additional resident attendance during peak hours, 2) immediate examination by residents prior to laboratory results, 3) chest X-ray at the ED instead of the external radiology department, 4) iv antibiotic administration at the ED instead of the ward and finally, 5) primary dipstick urine
analysis at the ED. A total of 295 patients were included (53.9% men), median age was 59 years (IQR 46 to 73). Median baseline DNT was 183 min (IQR 122 to 296). Implementation of the first three interventions did not reduce the DNT ; however, after implementation of the fourth (administer all antibiotics at the ED) and finally all five interventions the DNT was reduced by 15.3% (p=0.040) to a final median DNT of 155 min (IQR 95 to 221). Conclusion: Identification of delaying factors and
implementation of tailored interventions reduces the DNT .