Background: Sepsis is a leading cause of morbidity and mortality among hospitalized patients. Previous studies have demonstrated that rates of sepsis and its complications – including organ failure, readmission, and death – are higher among Black patients than white patients (1, 2). While some of these differences can be explained by socioeconomic inequities, comorbidities, and varying capabilities of hospitals by location, less is known about differences in care delivery within individual hospitals (1-4). It is well-established that delays in antibiotic administration are associated with higher in-hospital mortality rates, making time-to-antibiotics an opportune metric for analysis of care delivery in sepsis (5). Here we explore racial and other demographic differences in sepsis care delivery to identify disparities and ultimately improve the equity of sepsis care at our institution.
Methods: This retrospective, single-center study analyzed electronic health record (EHR) data of 7,809 adults hospitalized at a quaternary academic medical center and diagnosed with sepsis between January 2023 and June 2024. Sepsis was defined by meeting both the Centers for Disease Control (CDC) Adult Sepsis Event criteria and the Centers for Medicare and Medicaid Services (CMS) SEP-1 criteria during hospitalization. We analyzed the associations between differences in time from Emergency Department rooming to antibiotic administration (time-to-antibiotics) by patient race and need for interpreter using pooled t tests.
Results: Our analysis demonstrates a statistically significant difference in time-to-antibiotics between Black and white patients. The mean time-to-antibiotics in Black patients was 3.56 hours while in white patients it was 3.18 hours (95% CI for difference 0.10 to 0.65 hours, p=0.008). There was not a statistically significant difference in time-to-antibiotics between patients who were fluent in English compared to patients who required use of an interpreter, however there was a trend towards increased variability in time-to-antibiotics in the group requiring an English-language interpreter.
Conclusions: We found a statistically significant difference in time-to-antibiotics for Black patients as compared to white patients treated at our institution for sepsis. Further research is necessary to determine factors that may contribute to this disparity, and subsequent improvement work is crucial to ensure we are delivering equitable care for this deadly disease process. We also found a trend towards increased variability in time-to-antibiotics for patients who require an English-language interpreter as compared to those who do not, which could represent inequity in care delivery as well, and could be related to logistics such as interpreter availability, or other systemic or individual biases. Additionally, more work is needed to understand other disparities in sepsis and outcomes, including for patients of races and ethnicities besides Black and white, other demographic factors and social determinants of health, and other care delivery metrics besides time-to-antibiotics. Hospitalists must be aware of both systemic and local healthcare disparities and constantly work to overcome these.