An electronic warning system helps reduce the time to diagnosis of sepsis
| Autor: | Vanessa de Rossi Franzini, Lucimeri Albino, Rodolfo Bittencourt, Álvaro Koenig, Silvia Maria Fachin, Aline Braz Pereira, Geonice Sperotto, Maurício Gonçalves, Glauco Adrieno Westphal |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Hospital mortality Sepsis/diagnosis Critical Care and Intensive Care Medicine Cohort Studies Sepsis 03 medical and health sciences 0302 clinical medicine medicine Humans 030212 general & internal medicine Medical order entry systems Aged Warning system business.industry Alert 030208 emergency & critical care medicine General Medicine medicine.disease Anti-Bacterial Agents Telephone Mobile phone Antibiotic delivery Practice Guidelines as Topic Emergency medicine Early warning system Female Original Article Observational study Triage business Time to diagnosis Cohort study |
| Zdroj: | Revista Brasileira de Terapia Intensiva |
| ISSN: | 0103-507X |
| Popis: | To describe the improvements of an early warning system for the identification of septic patients on the time to diagnosis, antibiotic delivery, and mortality.This was an observational cohort study that describes the successive improvements made over a period of 10 years using an early warning system to detect sepsis, including systematic active manual surveillance, electronic alerts via a telephonist, and alerts sent directly to the mobile devices of nurses. For all periods, after an alert was triggered, early treatment was instituted according to the institutional sepsis guidelines.In total, 637 patients with sepsis were detected over the study period. The median triage-to-diagnosis time was reduced from 19:20 (9:10 - 38:15) hours to 12:40 (2:50 - 23:45) hours when the manual surveillance method was used (p = 0.14), to 2:10 (1:25 - 2:20) hours when the alert was sent automatically to the hospital telephone service (p = 0.014), and to 1:00 (0:30 - 1:10) hour when the alert was sent directly to the nurse's mobile phone (p = 0.016). The diagnosis-to-antibiotic time was reduced to 1:00 (0:55 - 1:30) hours when the alert was sent to the telephonist and to 0:45 (0:30 - 1:00) minutes when the alert was sent directly to the nurse's mobile phone (p = 0.02), with the maintenance of similar values over the following years. There was no difference in the time of treatment between survivors and non-survivors.Electronic systems help reduce the triage-to-diagnosis time and diagnosis-to-antibiotic time in patients with sepsis.Descrever os efeitos de melhorias sucessivas nos sistemas de alerta precoce para identificação de pacientes com sepse, no que se refere ao tempo até o diagnóstico, à administração de antibióticos e à mortalidade.Trata-se de um estudo observacional de coorte, que descreve as sucessivas melhorias implantadas em um período de 10 anos no sistema de alerta precoce para detecção de sepse, incluindo vigilância ativa manual sistemática, alertas eletrônicos via telefonista, e alertas enviados diretamente a dispositivos móveis da enfermagem. Para todos os períodos, após o desencadeamento do alerta, o tratamento foi realizado segundo as diretrizes institucionais para sepse.Durante estes anos, detectaram-se 637 pacientes com sepse. O tempo mediano entre a triagem e o diagnóstico foi reduzido de 19:20 (9:10 - 38:15) horas para 12:40 (2:50 - 23:45) horas quando se utilizou o método manual de vigilância (p = 0,14), para 2:10 (1:25 - 2:20) horas quando o alerta foi enviado automaticamente ao serviço telefônico do hospital (p = 0,014) e para 1:00 (0:30 - 1:10) horas quando o alerta foi enviado diretamente ao telefone celular da enfermagem (p = 0,02), com manutenção de valores similares nos anos que se seguiram. Não houve diferença no tempo até o tratamento em relação aos pacientes sobreviventes e não sobreviventes.Sistemas eletrônicos auxiliam na redução do tempo entre a triagem e o diagnóstico e entre o diagnóstico e o início da antibioticoterapia em pacientes com sepse. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|