Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED.

Autor: Hayden GE; 169 Ashley Ave, Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425. Electronic address: haydeng@musc.edu., Tuuri RE; 135 Rutledge Ave, Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425., Scott R; 169 Ashley Ave, Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425., Losek JD; 135 Rutledge Ave, Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425., Blackshaw AM; 96 Jonathan Lucas St, College of Medicine, Medical University of South Carolina, Charleston, SC, 29425., Schoenling AJ; 96 Jonathan Lucas St, College of Medicine, Medical University of South Carolina, Charleston, SC, 29425., Nietert PJ; 135 Cannon St, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425., Hall GA; 169 Ashley Ave, Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425.
Jazyk: angličtina
Zdroj: The American journal of emergency medicine [Am J Emerg Med] 2016 Jan; Vol. 34 (1), pp. 1-9. Date of Electronic Publication: 2015 Aug 28.
DOI: 10.1016/j.ajem.2015.08.039
Abstrakt: Background: Early identification of sepsis in the emergency department (ED), followed by adequate fluid hydration and appropriate antibiotics, improves patient outcomes.
Objectives: We sought to measure the impact of a sepsis workup and treatment protocol (SWAT) that included an electronic health record (EHR)-based triage sepsis alert, direct communication, mobilization of resources, and standardized order sets.
Methods: We conducted a retrospective, quasiexperimental study of adult ED patients admitted with suspected sepsis, severe sepsis, or septic shock. We defined a preimplementation (pre-SWAT) group and a postimplementation (post-SWAT) group and further broke these down into SWAT A (septic shock) and SWAT B (sepsis with normal systolic blood pressure). We performed extensive data comparisons in the pre-SWAT and post-SWAT groups, including demographics, systemic inflammatory response syndrome criteria, time to intravenous fluids bolus, time to antibiotics, length-of-stay times, and mortality rates.
Results: There were 108 patients in the pre-SWAT group and 130 patients in the post-SWAT group. The mean time to bolus was 31 minutes less in the postimplementation group, 51 vs 82 minutes (95% confidence interval, 15-46; P value < .01). The mean time to antibiotics was 59 minutes less in the postimplementation group, 81 vs 139 minutes (95% confidence interval, 44-74; P value < .01). Segmented regression modeling did not identify secular trends in these outcomes. There was no significant difference in mortality rates.
Conclusions: An EHR-based triage sepsis alert and SWAT protocol led to a significant reduction in the time to intravenous fluids and time to antibiotics in ED patients admitted with suspected sepsis, severe sepsis, and septic shock.
(Copyright © 2015 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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