Implementation of an adult code sepsis protocol and its impact on SEP-1 core measure perfect score attainment in the ED
Autor: | Dan Andrews, William R. Judd, Patrick D. Ratliff, Mark A. Sloan, Philip L. Whitfield, Lisa L. Lockhart, Kelsey L. Komyathy, Jeremy C. Leslie |
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Rok vydání: | 2020 |
Předmět: |
Male
medicine.medical_specialty Perfect score Cohort Studies Sepsis 03 medical and health sciences 0302 clinical medicine Clinical Protocols medicine Humans Severe sepsis Aged Retrospective Studies Aged 80 and over Protocol (science) Septic shock business.industry 030208 emergency & critical care medicine General Medicine Emergency department Middle Aged medicine.disease Shock Septic Emergency medicine Emergency Medicine Female Guideline Adherence Emergency Service Hospital business Medicaid Patient Care Bundles Cohort study |
Zdroj: | The American Journal of Emergency Medicine. 38:879-882 |
ISSN: | 0735-6757 |
DOI: | 10.1016/j.ajem.2019.07.002 |
Popis: | Timely management of sepsis has become an urgent concern among most hospitals. Institutions have been searching for unique ways to increase the quality of care and timely adherence to proven therapies. The objective of this study was to determine the impact of an Adult Code Sepsis Protocol on the rate of SEP-1 perfect score attainment (PSA) among patients who presented to the emergency department (ED) with severe sepsis or septic shock, as defined by the Centers for Medicare and Medicaid Services (CMS).This was a retrospective, observational cohort study in a 35-bed tertiary care hospital ED from December 2016 to February 2018. Adults (≥18 years of age) who met the CMS-case definition of severe sepsis or septic shock presenting to the ED either prior to or after implementation of an Adult Code Sepsis Protocol were included.The primary outcome of SEP-1 PSA, which was abstracted in an all-or-none fashion, increased from 30.7% to 71.3% (p 0.001). Inpatient mortality was reduced from 4% to 0% (p = 0.011) after protocol implementation. Protocol initiation also resulted in a significant reduction in both time to initiation of appropriate, empiric and effective antimicrobial therapy, based on culture results by 48 and 111 min, respectively (p 0.001). There were no significant differences in other secondary outcomes including ICU length-of-stay, readmission, or economic outcome measures.The addition of an Adult Code Sepsis Protocol in the ED significantly increased the rate of SEP-1 PSA, reduced inpatient mortality, and improved the time to initiation of effective antimicrobial therapy. |
Databáze: | OpenAIRE |
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