Decreased Time to Antibiotic Prophylaxis for Open Fractures at a Level One Trauma Center

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Abstract

Objective:

To determine whether time to administration of antibiotics decreased following the implementation of an open fracture working group and antibiotic prophylaxis protocol.

Design:

This is a retrospective cohort study. Fifty consecutive patients were enrolled prior to and following the formation of our working group and implementation of our recommendations. Descriptive statistics were used, chi-squared tests were used to evaluate categorical variables, and paired t-tests were used to analyze for statistical significance of time differences pre- and post-protocol.

Setting:

One Level One Trauma Center

Patients:

Adult patients sustaining open fractures that presented directly to our emergency room.

Main Outcome Measurements:

Our main outcome measures are time from entrance to the Emergency Department to ordering of antibiotics, time from ordering to administration of antibiotics, and time from entrance to the Emergency Department to administration of antibiotics.

Results:

After protocol implementation, time from admission to antibiotic administration decreased significantly from 123.1 to 35.7 minutes (p=0.0003). Each component decreased significantly: admission to order decreased from 94.1 to 26.1 minutes, and order to administration decreased from 29.0 to 9.5 minutes (p=0.0046, p=0.0003).

Conclusion:

Our study demonstrates a significantly reduced time to antibiotic prophylaxis for patients with open fractures following the implementation of a multidisciplinary working group. We hope that this provides a model for institutions to improve care and outcomes of these injuries.

Level of Evidence:

Therapeutic Level III

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