Development, testing, and refining the failure to rescue sepsis sniffer

开发、测试和改进拯救脓毒症嗅探器的失败

• 批准号: 8656483
• 负责人: Andrew Marc Harrison
• 金额: $ 4.29万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2014-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8656483
• 关键词: Development; testing; refining; failure; rescue

DESCRIPTION (provided by applicant): The purpose of this project is to develop, test, and refine an automated alert system to notify healthcare providers following failure to respond to sepsis in an appropriate and timely fashion. Because the majority of patients diagnosed with sepsis are elderly, this disease disproportionately impacts individuals with special health care needs, including the disabled, chronically ill, and those facing end-of-life. However, any patient can develop sepsis and require critical care hospitalization. Therefore, this project is relevant t the Agency for Healthcare Research and Quality's mission to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. Background: A major challenge in treating critical care patients is delay in initiating appropriate therapy upon sepsis diagnosis. Further, even when prompt therapy is initiated, it may be incomplete, inadequate, and/or hampered by provider error. Failure to respond to sepsis after diagnosis in a timely and appropriate manner can lead to complications, including organ dysfunction, refractory hypotension, multiple organ dysfunction syndrome, and death. Solution: Timely administration of appropriate therapy after diagnosis of sepsis has been demonstrated to significantly improve patient outcomes. With this in mind, our hypothesis is that an automated alert system for detecting failure to rescue after sepsis diagnosis can reduce time to achieve appropriate response in the ICU setting and thereby improve outcomes. The goal of this proposal is to develop and test an automated alert system for the detection of failure to rescue after sepsis diagnosis. To do this, we propose the following three specific aims: (1) improve the diagnostic performance of an existing severe sepsis "sniffer" (2) test different modes of automated alert delivery in experiment, and (3) pilot real-time testing of an improved severe sepsis alert system using the hospital electronic medical record. Our methods will include algorithm optimization, simulated experiment, and prospective testing in the critical care setting. The long-term goal of this proposal is to exploit this technology to improve patient outcomes and reduce overall adverse occurrence rates. This knowledge is significant as it will lay the foundation for the development of increasingly sophisticated automated detection systems to enhance the ability of providers to improve patient outcomes and reduce patient mortality.

描述（由申请人提供）：本项目的目的是开发、测试和完善自动警报系统，以在未能以适当和及时的方式对脓毒症做出反应后通知医疗保健提供者。由于大多数被诊断患有脓毒症的患者是老年人，这种疾病不成比例地影响具有特殊医疗保健需求的个人，包括残疾人，慢性病患者和面临生命终结的人。然而，任何患者都可能发生败血症并需要重症监护住院治疗。因此，该项目与医疗保健研究和质量机构的使命有关，该机构的使命是提高所有美国人医疗保健的质量、安全性、效率和有效性。背景：治疗重症监护患者的一个主要挑战是在脓毒症诊断后延迟启动适当的治疗。此外，即使在启动即时治疗时，其也可能是不完整的、不充分的和/或受到提供者错误的阻碍。在及时和适当的方式诊断后未能对脓毒症作出反应可导致并发症，包括器官功能障碍、难治性低血压、多器官功能障碍综合征和死亡。解决方案：已证明在诊断脓毒症后及时给予适当治疗可显著改善患者结局。考虑到这一点，我们的假设是，用于检测脓毒症诊断后抢救失败的自动警报系统可以缩短在ICU环境中实现适当响应的时间，从而改善结局。本提案的目标是开发和测试一种自动警报系统，用于检测脓毒症诊断后抢救失败。为此，我们提出了以下三个具体目标：（1）提高现有严重脓毒症“嗅探器”的诊断性能（2）在实验中测试不同模式的自动警报传递，以及（3）使用医院电子病历对改进的严重脓毒症警报系统进行试点实时测试。我们的方法将包括算法优化，模拟实验，并在重症监护设置的前瞻性测试。该提案的长期目标是利用该技术改善患者结局并降低总体不良事件发生率。这一知识意义重大，因为它将为开发日益复杂的自动检测系统奠定基础，以提高供应商改善患者预后和降低患者死亡率的能力。

项目成果

Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting.

ICU 环境中重症监护临床医生警报确认方法的比较。

• DOI: 10.7717/peerj.3083
• 发表时间: 2017
• 期刊: PeerJ
• 影响因子: 2.7
• 作者: Harrison,AndrewM;Thongprayoon,Charat;Aakre,ChristopherA;Jeng,JackY;Dziadzko,MikhailA;Gajic,Ognjen;Pickering,BrianW;Herasevich,Vitaly
• 通讯作者: Herasevich,Vitaly

Developing the surveillance algorithm for detection of failure to recognize and treat severe sepsis.

• DOI: 10.1016/j.mayocp.2014.11.014
• 发表时间: 2015-03
• 期刊: Mayo Clinic proceedings
• 影响因子: 8.9
• 作者: Harrison AM;Thongprayoon C;Kashyap R;Chute CG;Gajic O;Pickering BW;Herasevich V
• 通讯作者: Herasevich V