This cohort study across nationwide VA hospitals found that time-to-antibiotics for sepsis has declined over time. However, there remains significant variability in time-to-antibiotics not explained by patient characteristics, suggesting potential unwarranted practice variation in sepsis treatment.

Efforts to further accelerate time-to-antibiotics must be weighed against risks of over-treatment.

A total of 111,385 hospitalizations for sepsis were identified, including 107,547 men (96.6%) and 3838 women (3.4%) with a median (interquartile range [IQR]) age of 68 (62-77) years.

A total of 7,574 patients (6.8%) died in the hospital, and 13,855 patients (12.4%) died within 30 days.

Median (IQR) time-to-antibiotics was 3.9 (2.4-6.5) hours but differed by presenting characteristics.

Unadjusted median (IQR) time-to-antibiotics decreased over time, from 4.5 (2.7-7.1) hours during 2013 to 2014 to 3.5 (2.2-5.9) hours during 2017 to 2018 (P < .001).

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