Implementation of a real-time computerized sepsis alert in nonintensive care unit patients
Implementation of a real-time computerized sepsis alert in nonintensive care unit patients
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DOI：
10.1097/ccm.0b013e318205df85
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发表时间：
2011-03-01
影响因子：
8.8
通讯作者：
Kollef, Marin H.
中科院分区：
文献类型：
--
作者：
Sawyer, Amber M.;Deal, Eli N.;Kollef, Marin H.
目的：脓毒症的早期治疗包括液体复苏和抗生素应用，已被证明能改善患者的预后。一种积极主动的工具来识别有患脓毒症风险的患者，可能会减少干预时间并改善患者的预后。这项研究的目的是评估实施自动脓毒症筛查和警报系统是否有助于早期适当的干预。设计：前瞻性、观察性、先导性研究。地点：巴恩斯犹太医院的六个内科病房，一个有1250张床位的学术医疗中心。患者：通过脓毒症筛查确定进入内科病房的患者包括在研究中。共有300名患者被确定，其中包括非干预组(n=200)和干预组(n=100)。干预：对干预组实施实时败血症警报，并以文本页面的形式通知患者医院病房的主管护士。测量和主要结果：在脓毒症警报的12小时内，评估治疗医生的干预措施，包括新的或升级的抗生素、静脉输液、氧疗、血管升压剂和诊断测试。排除非积极治疗的患者后，对非干预组181名患者和干预组89名患者进行分析。在败血症警报发出的12小时内，干预组70.8%的患者接受了>；=1干预，而非干预组只有55.8%(p=.018)。在干预组中，抗生素升级、静脉输液、氧疗和诊断试验都增加了。这是一个单中心、机构和患者特定的算法。结论：巴恩斯-犹太医院开发的脓毒症警报显示，增加了对有脓毒症风险的非重症监护病房患者的早期治疗和诊断干预。(Crit Care Med 2011；39：469-473)
Objective: Early therapy of sepsis involving fluid resuscitation and antibiotic administration has been shown to improve patient outcomes. A proactive tool to identify patients at risk for developing sepsis may decrease time to interventions and improve patient outcomes. The objective of this study was to evaluate whether the implementation of an automated sepsis screening and alert system facilitated early appropriate interventions.Design: Prospective, observational, pilot study.Setting: Six medicine wards in Barnes-Jewish Hospital, a 1250-bed academic medical center.Patients: Patients identified by the sepsis screen while admitted to a medicine ward were included in the study. A total of 300 consecutive patients were identified comprising the nonintervention group (n = 200) and the intervention group (n = 100).Interventions: A real-time sepsis alert was implemented for the intervention group, which notified the charge nurse on the patient's hospital ward by text page.Measurements and Main Results: Within 12 hrs of the sepsis alert, interventions by the treating physicians were assessed, including new or escalated antibiotics, intravenous fluid administration, oxygen therapy, vasopressors, and diagnostic tests. After exclusion of patients without commitment to aggressive management, 181 patients in the nonintervention group and 89 patients in the intervention group were analyzed. Within 12 hrs of the sepsis alert, 70.8% of patients in the intervention group had received >= 1 intervention vs. 55.8% in the nonintervention group (p = .018). Antibiotic escalation, intravenous fluid administration, oxygen therapy, and diagnostic tests were all increased in the intervention group. This was a single-center, institution-and patient-specific algorithm.Conclusions: The sepsis alert developed at Barnes-Jewish Hospital was shown to increase early therapeutic and diagnostic interventions among nonintensive care unit patients at risk for sepsis. (Crit Care Med 2011; 39: 469-473)