Assessing Racial Disparities in Sepsis Diagnosis and Treatment in the Emergency Department: Impact of Standardized Sepsis Care Initiatives

Emergency departments (ED) diagnose approximately half of the 1.7 million patients with sepsis annually, making them a critical site for early recognition and treatment. National and institutional initiatives have emphasized standardized sepsis pathways to improve timeliness of care and outcomes. In parallel, reducing racial disparities in emergency care remains a major healthcare priority, as differences in ED treatment and outcomes by race are well documented. We evaluated whether racial differences in sepsis severity at presentation and timeliness of early treatment persist following implementation of a sepsis team in a large integrated health system.

This was a retrospective cohort of adult patients who presented to a hospital-based ED within a large integrated healthcare system between January 1, 2021, and July 31, 2024, who had an ED diagnosis of sepsis or septic shock and had a multispecialty sepsis team alerted to be present at bedside. Patient data were extracted from the electronic medical record by a dedicated analyst blinded to study aims. Demographics, area deprivation index (ADI), clinical presentation, and hospital course were collected. Multivariable logistic regression was used to assess the association between race and septic shock at presentation and receipt of antibiotics within one hour, adjusting for age, sex, insurance, and Charlson Comorbidity Index.

Patients (n=41,164) tended to be white (74%), male (52%), have Medicare (53%), and resided in medium to medium-high area deprivation index (ADI) (65%). Black patients were younger (median 65 vs 71) and had higher ADIs (71% vs 27%). Black patients had higher odds of septic shock at ED presentation (adjusted OR 1.17,95% CI 1.10–1.25). Time to diagnosis, lactate measurement, and fluid administration did not differ by race. Black patients experienced a modestly longer time to antibiotics (mean difference 6 minutes, 95% CI 2.4–9.6), but the one-hour antibiotic pass rate was high (85%) and was not associated with race.

Within a system using ED sepsis teams, racial differences in most early sepsis process-of-care measures were minimal despite greater illness severity at presentation among Black patients. These findings suggest that structured sepsis protocols may promote more equitable emergency care delivery, though small delays in antibiotic administration warrant further study.