Physician Variation in Early Sepsis Management
Main finding · Overtreatment (infection ruled out on final retrospective adjudication) by physician door-to-antimicrobial practice patternResult — go to the resultAdjusted odds ratio 0.98 95% CI 0.94–1.02Authors' conclusion
In this mixed-methods study, ED physicians' antimicrobial administration time for sepsis varied significantly, but faster antimicrobial initiation practice patterns were not associated with overtreatment.
Study context
- Population
- Emergency department (ED) attending physicians and their patients meeting sepsis criteria (incl. IV antimicrobial administration) before ED departure, 4 Utah EDs, 2013–201788 ED physicians
- Participants
- 9,810 participants
- Exposure
- Physician door-to-antimicrobial time practice patterns vs overtreatment rate
- Outcome
- Association of physicians' door-to-antimicrobial practice patterns with their overtreatment rate (infection ruled out on final retrospective adjudication)
Methodological detailsretrospective cohort with prospective qualitative interviews, 4 Utah EDs, 30-day follow-up, semistructured cognitive task analysis interviews, Median patient encounters per physician 105 (IQR, 75-129)
- Retrospective cohort with prospective qualitative interviews
- 4 Utah EDs
- 30-day follow-up
- Semistructured cognitive task analysis interviews
- Median patient encounters per physician 105 (IQR, 75-129)
Main finding
As reported in the abstract
Overtreatment (infection ruled out on final retrospective adjudication) by physician door-to-antimicrobial practice pattern
Adjusted odds ratio
0.98
95% CI 0.94–1.02
P = 0.37
Per 10-minute increase in physician estimated mean door-to-antimicrobial time
adjusted odds ratio 0.98 (95% CI 0.94–1.02); P = 0.37
Per 10-minute increase in physician estimated mean, as printed
- Physicians' door-to-antimicrobial time varied significantly (likelihood ratio test)
- P < 0.001
- Average physician-level estimated mean door-to-antimicrobial time for a typical patient, minutes (95% estimation interval, 146-222)
- 184
Observational data: associations, not effects.
Further findings
Physician variation in door-to-antimicrobial time
- Varied significantly (likelihood ratio test)
- P < 0.001
- Average physician-level estimated mean door-to-antimicrobial time for a typical patient, minutes (95% estimation interval 146-222)
- 184
Patients receiving antimicrobials >3 hours after ED arrival
- Patients, n (%)
- 3540 (38.6%)
Qualitative interviews (fastest vs slowest quartiles)
- Faster physicians emphasized proactive, parallel task execution and care team coordination; slower physicians described a more reactive, stepwise sepsis evaluation and treatment process
- 18 physicians interviewed
Original publication
Physician Variation in Early Sepsis Management. JAMA Netw Open. Published 2 February 2026. doi:10.
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