A quality improvement project to improve early sepsis care in the emergency department
A quality improvement project to improve early sepsis care in the emergency department
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DOI：
10.1136/bmjqs-2014-003552
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发表时间：
2015-12-01
影响因子：
5.4
通讯作者：
Durvasula, Raghu
中科院分区：
文献类型：
--
作者：
Gatewood, Medley O'Keefe;Wemple, Matthew;Durvasula, Raghu
背景脓毒症导致住院患者的发病率和死亡率很高。尽管许多研究描述了在严重脓毒症和脓毒性休克患者的管理中使用方案的使用，但很少涉及对最初出现无并发症脓毒症的患者（即没有器官衰竭或低血压的患者）进行急诊科（ED）筛查和管理。 目的 一家大型四级护理转诊医院的质量改进工作组试图制定一个方案，重点关注除严重脓毒症和脓毒性休克之外的无并发症脓毒症患者的早期识别。 干预 三层干预包括(1) 护士驱动的筛查工具和管理方案，用于识别脓毒症患者并开始早期治疗，(2) 计算机辅助筛查算法，在电子病历中生成“脓毒症警报”弹出屏幕，用于治疗临床医疗保健提供者，以及 (3) 自动建议脓毒症特定顺序集，用于初始检查和复苏、抗生素选择和目标导向治疗。设计 A 在回顾性队列研究前后进行，以确定干预措施对遵守推荐的脓毒症管理（包括血清）的影响在急诊科测量乳酸，在分诊后 2 小时内注射 2 L 静脉输液，在分诊后 3 小时内注射抗生素，并在抗生素注射前抽取血培养物。还分析了入院时出现脓毒症指定 ICD-9 代码的急诊室患者的死亡率。结果 总体束合规性增加了 154%，从基线时的 28% 增加到研究最后一个季度的 71%（p
Background Sepsis causes substantial morbidity and mortality in hospitalised patients. Although many studies describe the use of protocols in the management of patients with severe sepsis and septic shock, few have addressed emergency department (ED) screening and management for patients initially presenting with uncomplicated sepsis (ie, patients without organ failure or hypotension).Objective A quality improvement task force at a large, quaternary care referral hospital sought to develop a protocol focusing on early identification of patients with uncomplicated sepsis, in addition to severe sepsis and septic shock.Intervention The three-tiered intervention consisted of (1) a nurse-driven screening tool and management protocol to identify and initiate early treatment of patients with sepsis, (2) a computer-assisted screening algorithm that generated a 'Sepsis Alert' pop-up screen in the electronic medical record for treating clinical healthcare providers and (3) automated suggested sepsis-specific order sets for initial workup and resuscitation, antibiotic selection and goal-directed therapy.Design A before and after retrospective cohort study was undertaken to determine the intervention's impact on compliance with recommended sepsis management, including serum lactate measured in the ED, 2 L of intravenous fluid administered within 2 h of triage, antibiotics administered within 3 h of triage and blood cultures drawn before antibiotic administration. Mortality rates for patients in the ED with a sepsis-designated ICD-9 code present on admission were also analysed. Results Overall bundle compliance increased by 154%, from 28% at baseline to 71% in the last quarter of the study (p