• C F J van Tuijn, J S Luitse, M van der Valk, S van Wissen, M Prins, R Rosmulder, and S E Geerlings.
• Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands. c.f.vantuijn@amc.uva.nl
• Neth J Med. 2010 Mar 1;68(3):123-7.

BackgroundDoor-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.MethodsAll adult patients arriving at the ED with a suspected infection for whom admission and iv antibiotics were indicated were included.ResultsFirstly, 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).ConclusionIdentification of delaying factors and implementation of tailored interventions reduces the DNT .

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