SEPSIS KILLS: early intervention saves lives
| Autor: | Doungkamol Sindhusake, Anthony R Burrell, Mary Fullick, Mary-Louise McLaws, Rosemary B Sullivan |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Resuscitation
medicine.medical_specialty Time Factors Bacteremia Guidelines as Topic Sepsis 03 medical and health sciences 0302 clinical medicine Risk Factors Intensive care medicine Humans Lactic Acid Prospective Studies 030212 general & internal medicine Survival rate Aged Retrospective Studies business.industry Incidence Incidence (epidemiology) Mortality rate 030208 emergency & critical care medicine General Medicine Length of Stay Middle Aged medicine.disease Anti-Bacterial Agents Surgery Survival Rate Blood Early Diagnosis Blood pressure Anesthesia Fluid Therapy New South Wales Emergency Service Hospital business Biomarkers |
| Zdroj: | Medical Journal of Australia. 204:73-73 |
| ISSN: | 1326-5377 0025-729X |
| DOI: | 10.5694/mja15.00657 |
| Popis: | OBJECTIVE To implement a statewide program for the early recognition and treatment of sepsis in New South Wales, Australia. SETTING Ninety-seven emergency departments in NSW hospitals. INTERVENTION A quality improvement program (SEPSIS KILLS) that promoted intervention within 60 minutes of recognition, including taking of blood cultures, measuring serum lactate levels, administration of intravenous antibiotics, and fluid resuscitation. MAIN OUTCOME MEASURES Time to antibiotics and fluid resuscitation; mortality rates and length of stay. RESULTS Data for 13 567 patients were entered into the database. The proportion of patients receiving intravenous antibiotics within 60 minutes of triage increased from 29.3% in 2009-2011 to 52.2% in 2013. The percentage for whom a second litre of fluid was started within 60 minutes rose from 10.6% to 27.5% (each P < 0.001). The proportion of patients classed as Australasian Triage Scale (ATS) 1 increased from 2.3% in 2009-2011 to 4.2% in 2013, and the proportion classed as ATS 2 rose from 40.7% in 2009-2011 to 60.7% in 2013 (P < 0.001). There was a linear decrease in mortality from 19.3% in 2009-2011 to 14.1% in 2013; there was also a significant decline in time in intensive care and total length of stay (each P < 0.0001). The mortality rate for patients with severe sepsis (serum lactate ≥ 4 mmol/L or systolic blood pressure [SBP] < 90 mmHg) was 19.7%. The mortality rates for patients with severe sepsis admitted to intensive care and for those admitted to a ward did not change significantly over time. The proportion of patients with uncomplicated sepsis (SBP ≥ 90 mmHg, serum lactate < 4 mmol/L) transferred to a ward increased, and the mortality rate after transfer increased from 3.2% in 2009-2011 to 6.2% in 2013 (P < 0.05). The survival benefit was greatest for patients with evidence of haemodynamic instability (SBP < 90 mmHg) but normal lactate levels (P = 0.03). CONCLUSIONS The SEPSIS KILLS program has improved the process of care for patients with sepsis in NSW hospitals. The program has focused attention on sepsis management in the wards. |
| Databáze: | OpenAIRE |
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