How Physician Heterogeneity May Matter in Sepsis Care

During the past decade, we have embraced the idea that not all patients with sepsis are alike; we aim to characterize phenotypes and personalize treatment to improve outcomes. [1][2]2][3] However, we frequently ignore the differences between health care practitioners who treat sepsis, despite evidence that acute care delivery varies widely across individual clinicians. 4,5Peltan et al 6 used a mixed-methods study to explore physician-level heterogeneity and its association with sepsis management.Using data from 9810 emergency department (ED) patients who met criteria for sepsis across 4 hospitals in Utah (2013-2017) and the 88 physicians caring for them, they found significant variability across physicians in the estimated mean door-to-antimicrobial time (184 [95% prediction interval, 146-222] minutes).They next explored the concern that faster prescribing physicians may overtreat, defined as administering antimicrobials to patients ultimately ruled out for sepsis on retrospective evaluation of ED and post-ED clinical documentation and diagnostic testing results.Using joint regression, they demonstrated no association between physician mean door-toantimicrobial time and overtreatment (adjusted odds ratio for every 10-minute door-toantimicrobial time increase, 0.98 [95% CI, 0.94-1.02];P = .37).Finally, they interviewed 18 of the 88 ED physicians (in 2022 to 2023).Using thematic analysis, they found that the physicians with shorter door-to-antimicrobial times emphasized proactive, parallel task execution and care coordination, while those with longer times used a more reactive and stepwise approach.Peltan et al 6 concluded that, first, these data may allay concerns that expediting antimicrobial administration for all patients with sepsis will lead to overtreatment, and second, helping clinicians with longer door-toantimicrobial times gain confidence in their ability to overcome systems barriers and coordinate care delivery may be an effective strategy to accomplish this treatment acceleration.The beauty of this study stems from its elegant combination of quantitative and qualitative methods.The findings from the quantitative analyses identified the physicians to be evaluated using