Clinical and Economic Impact of a Quality Improvement Initiative to Enhance Early Recognition and Treatment of Sepsis
Clinical and Economic Impact of a Quality Improvement Initiative to Enhance Early Recognition and Treatment of Sepsis
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DOI：
10.1177/1060028014541792
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发表时间：
2014-10-01
影响因子：
2.9
通讯作者：
Kennedy, Charles A.
中科院分区：
文献类型：
--
作者：
Judd, William R.;Stephens, Dana M.;Kennedy, Charles A.
背景资料：需要研究评估脓毒症筛查工具和方法的临床有效性，以改善从诊断到抗生素给药的时间，以改善脓毒症相关的结果。目的：评估脓毒症质量改进计划的临床和经济影响，以改善脓毒症的早期识别和治疗。方法：在一家拥有433张床位的三级医疗中心对脓毒症成人患者进行回顾性观察研究。从2013年7月至9月收集了181例脓毒症诊断相关组（DRG）编码分配患者的基线数据。干预组包括2013年10月至12月的216名患者。制定了首剂STAT抗生素政策，并指导护士每班完成一次电子败血症筛查工具。主要结果包括住院死亡率和重症监护室（ICU）住院时间（LOS）。次要结局包括总体LOS和每例费用。结果如下：在脓毒症DRG患者中观察到总体LOS（7.43 +/- 5.68天vs 6.77 +/- 5天; P = 0.138）和住院死亡率（13.8% vs 8.8%; P = 0.113）无显著性降低。早期识别和治疗有助于显著降低ICU LOS（5.85 +/- 4.38天vs 4.21 +/- 3.64天; P = 0.003）和每个病例的总费用（14378美元vs 12311美元; P = 0.033）。最高疾病严重程度DRG编码分配的百分比从7.9%降至0%。结论：改善脓毒症早期识别和治疗的策略，包括常规使用电子脓毒症筛查工具和实施首剂STAT抗生素政策，有助于显著降低ICU LOS和每例费用。
Background: Studies evaluating the clinical effectiveness of sepsis screening tools and methods to improve the time from diagnosis to antibiotic administration are needed to improve sepsis-related outcomes. Objective: To evaluate the clinical and economic impact of a sepsis quality improvement initiative to improve early recognition and treatment of sepsis. Methods: A retrospective observational study of adults with sepsis was performed in a 433-bed tertiary medical center. Baseline data were collected for 181 patients with sepsis diagnosis-related group (DRG) coding assignments from July through September 2013. The intervnetion group included 216 patients from October through December 2013. A First-Dose STAT Antibiotic policy was developed, and nurses were instructed to complete an electronic sepsis screening tool once per shift. Primary outcomes included in-hospital mortality and intensive care unit (ICU) length of stay (LOS). Secondary outcomes included overall LOS and cost per case. Results: Nonsignificant decreases in overall LOS (7.43 +/- 5.68 days vs 6.77 +/- 5 days; P = 0.138) and in-hospital mortality (13.8% vs 8.8%; P = 0.113) were observed in patients with sepsis DRGs. Early recognition and treatment contributed to significant reductions in ICU LOS (5.85 +/- 4.38 days vs 4.21 +/- 3.64 days; P = 0.003) and total cost per case ($14 378 vs $12 311; P = 0.033). The percentage of highest disease-severity DRG coding assignments decreased from 7.9% to 0%. Conclusions: Strategies to improve early recognition and treatment of sepsis, including routine use of an electronic sepsis screening tool and implementation of a First-Dose STAT Antibiotic policy, contributed to significant reductions in ICU LOS and cost per case.