Managing Diagnostic Uncertainty in Pediatric Sepsis Quality Improvement with a Two-Tiered Approach.
Managing Diagnostic Uncertainty in Pediatric Sepsis Quality Improvement with a Two-Tiered Approach.
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使用两层方法管理儿科脓毒症质量改进的诊断不确定性。
DOI：
10.1097/pq9.0000000000000244
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发表时间：
2020
影响因子：
1.1
通讯作者：
Bajaj,Lalit
中科院分区：
文献类型：
--
作者：
Scott,HaldenF;Kempe,Allison;DeakyneDavies,SaraJ;Krack,Paige;Leonard,Jan;Rolison,Elise;Mackenzie,Joan;Wathen,Beth;Bajaj,Lalit
方法：在6个儿科急诊科和急救中心实施两级临床路径，包括订单集、教育、寻呼。脓毒症统计途径包括2名护士，手动输送抗生素，复苏室使用。脓毒症黄色路径包括优先顺序，标准化程序，密切监测，并评估是否需要抗生素。结果：从2012年4月至2017年12月，我们治疗了3，640例疑似和确诊脓毒症患者。在932例严重脓毒症患者中，30天住院死亡率为0.9%。到达识别时间从50分钟缩短到4分钟。对抗生素时间的识别证明了在我们的目标范围内的控制过程，脓毒症患者的中位数为43分钟，黄色脓毒症患者为59分钟。需要重症监护室护理的严重脓毒症患者比例从45%下降到34%。在脓毒症黄色途径中，23%的患者在没有使用抗生素的情况下出院回家。结论：这种在不同紧急护理环境中改善儿科脓毒症质量的新型两级方法改善了严重脓毒症的流程和结果措施，同时促进了管理和降级在适当的情况下。将资源与疾病程度相匹配对于支持潜在脓毒症儿童的优质护理非常重要。
Methods:A 2-tiered clinical pathway was implemented at 6 pediatric emergency departments and urgent care centers, incorporating order sets, education, paging. The Sepsis Stat pathway included 2 nurses, hand delivery of antibiotics, resuscitation room use. The Sepsis Yellow pathway included prioritized orders, standardized procedures, close monitoring, and evaluation of whether antibiotics were warranted.Results:From April 2012 to December 2017, we treated 3,640 patients with suspected and confirmed sepsis. Among the 932 severe sepsis patients, the 30-day, in-hospital mortality was 0.9%. Arrival to recognition time improved from 50 to 4 minutes. Recognition to antibiotic time demonstrated an in-control process in our goal range with a median of 43 minutes for Sepsis Stat patients, 59 minutes for Sepsis Yellow patients. The proportion of severe sepsis patients requiring intensive care unit care declined from 45% to 34%. On the Sepsis Yellow pathway, 23% were de-escalated with discharge to home without antibiotics.Conclusions:This novel 2-tiered approach to pediatric sepsis quality improvement in varied emergency care settings improved process and outcome measures in severe sepsis while promoting stewardship and de-escalation where appropriate. Matching resources to the degree of illness was important in supporting quality care in potentially septic children.