Pilot Quality Improvement Project to Accelerate Antibiotic Delivery in the Surgical ICU

Introduction: Sepsis remains a major cause of death worldwide. Prompt administration of antibiotics along with effective source control have been emphasized for decades, with a linear positive correlation of increased mortality with each hour delay in antibiotic therapy. While the importance of timely administration of antibiotics has been a critical focus of discussion, guidance on how to achieve this goal is limited. Existing studies focus on adherence to sepsis protocols and consequences of therapy delays mainly in the Emergency Department. Our study aims to improve timely antibiotic delivery in the Surgical ICU.


Methods: This is a prospective quality improvement project scaled on 30 surgical ICU beds at Cleveland Clinic. Benchmarking marking data was collected retrospectively from EMR(Jan2025-June2025). The antibiotics of interest were cefepime, ceftriaxone, piperacillin-tazobactam and meropenem. The intervention included formation of a multi-disciplinary team, structured education, and process modification including development of a new workflow focusing on method of ordering, closed loop communication and monitoring. A Data Dashboard was utilized for continuous monitoring of any fall outs defined as new initiation of broad spectrum antibiotics administered in over 60 minutes.


Results: During the pilot QI period, a total of 150 antibiotics were newly initiated, 114 pre-intervention, 36 post-intervention . 35% were ordered stat in the pre-intervention period vs 47% post-intervention. The mean time to antibiotics was 50 minutes(SD:42, Median:42) pre-intervention. This number improved to 29 minutes(SD:22, Median:23) post-intervention. The mean difference in time reduction was 27 minutes (p: 0.002,95%CI: -44.71,-9.93).


Conclusions: Efforts to accelerate timing of antibiotic administration through structured quality improvement initiatives show promise in enhancing sepsis treatment. This small pilot study provides a workflow for achieving this goal. Future studies are needed to evaluate sustainability of QI processes focused on antibiotic administration and long term impact of timely administration of antibiotics on surgical site infections, mortality and ICU length of stay. Involvement of multi-disciplinary collaboration is essential in effective care delivery in the ICU.