Four consecutive yearly point-prevalence studies in Wales indicate lack of improvement in sepsis care on the wards.

Autor: Kopczynska M; Salford Royal NHS Foundation Trust, Manchester, UK., Unwin H; Cardiff University School of Medicine, Cardiff, UK., Pugh RJ; Intensive Care Medicine Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Bodelwyddan, UK., Sharif B; Prince Charles Hospital, Cwm Taf Morgannwg University Health Board, Merthyr Tydfil, UK., Chandy T; The Grange University Hospital, Aneurin Bevan University Health Board, Cwmbran, Wales, UK., Davies DJ; College of Medicine, Swansea University Medical School, Swansea, UK., Shield ME; College of Medicine, Swansea University Medical School, Swansea, UK., Purchase DE; Cardiff University School of Medicine, Cardiff, UK., Tilley SC; Cardiff University School of Medicine, Cardiff, UK., Poacher A; Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK., Oliva L; Cardiff University School of Medicine, Cardiff, UK., Willis S; Glangwili General Hospital, Hywel Dda University Health Board, Carmarthen, UK., Ray IE; Cardiff University School of Medicine, Cardiff, UK., Hui JNC; The Grange University Hospital, Aneurin Bevan University Health Board, Cwmbran, Wales, UK., Payne BC; Cardiff University School of Medicine, Cardiff, UK., Wardle EF; Cardiff University School of Medicine, Cardiff, UK., Andrew F; Cardiff University School of Medicine, Cardiff, UK., Chan HMP; Prince Charles Hospital, Cwm Taf Morgannwg University Health Board, Merthyr Tydfil, UK., Barrington J; Cardiff University School of Medicine, Cardiff, UK., Hale J; Cardiff University School of Medicine, Cardiff, UK., Hawkins J; Cardiff University School of Medicine, Cardiff, UK., Nicholas JK; Cardiff University School of Medicine, Cardiff, UK., Wirt LE; Cardiff University School of Medicine, Cardiff, UK., Thomas LH; Cardiff University School of Medicine, Cardiff, UK., Walker M; Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK., Pan MP; Cardiff University School of Medicine, Cardiff, UK., Ray T; Cardiff University School of Medicine, Cardiff, UK., Asim UH; Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK., Maidman V; Cardiff University School of Medicine, Cardiff, UK., Atiyah Z; Cardiff University School of Medicine, Cardiff, UK., Nasser ZM; Cardiff University School of Medicine, Cardiff, UK., Tan ZX; West Suffolk NHS Foundation Trust, Bury St Edmunds, Suffolk, UK., Tan LJP; University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK., Szakmany T; Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Cardiff, UK. SzakmanyT1@cardiff.ac.uk.; Intensive Care Medicine, Critical Care Directorate, Grange University Hospital, Aneurin Bevan University Health Board, Cwmbran, UK. SzakmanyT1@cardiff.ac.uk.
Jazyk: angličtina
Zdroj: Scientific reports [Sci Rep] 2021 Aug 10; Vol. 11 (1), pp. 16222. Date of Electronic Publication: 2021 Aug 10.
DOI: 10.1038/s41598-021-95648-6
Abstrakt: The 'Sepsis Six' bundle was promoted as a deliverable tool outside of the critical care settings, but there is very little data available on the progress and change of sepsis care outside the critical care environment in the UK. Our aim was to compare the yearly prevalence, outcome and the Sepsis Six bundle compliance in patients at risk of mortality from sepsis in non-intensive care environments. Patients with a National Early Warning Score (NEWS) of 3 or above and suspected or proven infection were enrolled into four yearly 24-h point prevalence studies, carried out in fourteen hospitals across Wales from 2016 to 2019. We followed up patients to 30 days between 2016-2019 and to 90 days between 2017 and 2019. Out of the 26,947 patients screened 1651 fulfilled inclusion criteria and were recruited. The full 'Sepsis Six' care bundle was completed on 223 (14.0%) occasions, with no significant difference between the years. On 190 (11.5%) occasions none of the bundle elements were completed. There was no significant correlation between bundle element compliance, NEWS or year of study. One hundred and seventy (10.7%) patients were seen by critical care outreach; the 'Sepsis Six' bundle was completed significantly more often in this group (54/170, 32.0%) than for patients who were not reviewed by critical care outreach (168/1385, 11.6%; p < 0.0001). Overall survival to 30 days was 81.7% (1349/1651), with a mean survival time of 26.5 days (95% CI 26.1-26.9) with no difference between each year of study. 90-day survival for years 2017-2019 was 74.7% (949/1271), with no difference between the years. In multivariate regression we identified older age, heart failure, recent chemotherapy, higher frailty score and do not attempt cardiopulmonary resuscitation orders as significantly associated with increased 30-day mortality. Our data suggests that despite efforts to increase sepsis awareness within the NHS, there is poor compliance with the sepsis care bundles and no change in the high mortality over the study period. Further research is needed to determine which time-sensitive ward-based interventions can reduce mortality in patients with sepsis and how can these results be embedded to routine clinical practice.Trial registration Defining Sepsis on the Wards ISRCTN 86502304 https://doi.org/10.1186/ISRCTN86502304 prospectively registered 09/05/2016.
(© 2021. The Author(s).)
Databáze: MEDLINE
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