Managing sepsis: Electronic recognition, rapid response teams, and standardized care save lives

被引:54
作者
Guirgis, Faheem W. [1 ]
Jones, Lisa [2 ]
Esma, Rhemar [3 ]
Weiss, Alice [3 ]
McCurdy, Kaitlin [4 ]
Ferreira, Jason [5 ]
Cannon, Christina [1 ]
McLauchlin, Laura [6 ]
Smotherman, Carmen [7 ]
Kraemer, Dale F. [7 ]
Gerdik, Cynthia [8 ]
Webb, Kendall [1 ]
Ra, Jin [9 ]
Moore, Frederick A. [10 ]
Gray-Eurom, Kelly [1 ]
机构
[1] Univ Florida, Coll Med, Dept Emergency Med, Jacksonville, FL USA
[2] Univ Florida, Coll Med, Dept Med, Div Pulm Crit Care Med, Jacksonville, FL USA
[3] UF Hlth Jacksonville, Qual Management, Jacksonville, FL 32209 USA
[4] Univ Florida, Coll Med, Dept Med, Jacksonville, FL USA
[5] Univ Florida, Coll Pharm, Jacksonville, FL USA
[6] Univ Florida, Coll Med, Dept Neurosurg, Jacksonville, FL USA
[7] Univ Florida, Coll Med, Ctr Hlth Equ & Qual Res, Jacksonville, FL USA
[8] UF Hlth Jacksonville, Jacksonville, FL 32209 USA
[9] Univ Florida, Coll Med, Dept Surg, Jacksonville, FL USA
[10] Univ Florida, Coll Med, Dept Surg, Gainesville, FL USA
关键词
Sepsis; Rapid response teams; Clinical decision support; Resuscitation; INTERNATIONAL CONSENSUS DEFINITIONS; SEPTIC SHOCK; BUNDLES; IMPACT;
D O I
10.1016/j.jcrc.2017.04.005
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose: Sepsis can lead to poor outcomes when treatment is delayed or inadequate. The purpose of this study was to evaluate outcomes after initiation of a hospital-wide sepsis alert program. Materials and methods: Retrospective review of patients >= 18 years treated for sepsis. Results: Therewere 3917 sepsis admissions: 1929 admissions before, and 1988 in the after phase. Mean age (57.3 vs. 57.1, p=0.94) and Charlson Comorbidity Scores (2.52 vs. 2.47, p= 0.35) were similar between groups. Multivariable analyses identified significant reductions in the after phase for odds of death (OR 0.62, 95% CI 0.390.99, p = 0.046), mean intensive care unit LOS (2.12 days before, 95% CI 1.97, 2.34; 1.95 days after, 95% CI 1.75, 2.06; p b 0.001), mean overall hospital LOS (11.7 days before, 95% CI 10.9, 12.7 days; 9.9 days after, 95% CI 9.3, 10.6 days, p < 0.001), odds ofmechanical ventilation use (OR 0.62, 95% CI 0.39, 0.99, p=0.007), and total charges with a savings of $7159 per sepsis admission (p = 0.036). There was no reduction in vasopressor use (OR 0.89, 95% CI 0.75, 0.1.06, p= 0.18). Conclusion: A hospital- wide program utilizing electronic recognition and RRT intervention resulted in improved outcomes in patients with sepsis. (C) 2017 Elsevier Inc. All rights reserved.
引用
收藏
页码:296 / 302
页数:7
相关论文
共 23 条
[1]   NEW LOOK AT STATISTICAL-MODEL IDENTIFICATION [J].
AKAIKE, H .
IEEE TRANSACTIONS ON AUTOMATIC CONTROL, 1974, AC19 (06) :716-723
[2]  
[Anonymous], CRIT CARE MED
[3]  
[Anonymous], 2014, NEW ENGL J MED, DOI DOI 10.1056/NEJMoa1401602
[4]   LATE COMPLIANCE WITH THE SEPSIS RESUSCITATION BUNDLE: IMPACT ON MORTALITY [J].
Castellanos-Ortega, Alvaro ;
Suberviola, Borja ;
Garcia-Astudillo, Luis A. ;
Ortiz, Fernando ;
Llorca, Javier ;
Delgado-Rodriguez, Miguel .
SHOCK, 2011, 36 (06) :542-547
[5]  
Coba Victor, 2011, J Intensive Care Med, V26, P304, DOI 10.1177/0885066610392499
[6]   Computer versus paper system for recognition and management of sepsis in surgical intensive care [J].
Croft, Chasen A. ;
Moore, Frederick A. ;
Efron, Philip A. ;
Marker, Peggy S. ;
Gabrielli, Andrea ;
Westhoff, Lynn S. ;
Lottenberg, Lawrence ;
Jordan, Janeen ;
Klink, Victoria ;
Sailors, R. Matthew ;
McKinley, Bruce A. .
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 2014, 76 (02) :311-319
[7]  
DELLINGER RP, 2013, INTENS CARE MED, V39, P165, DOI DOI 10.1007/s00134-012-2769-8
[8]   The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational study [J].
Gao, F ;
Melody, T ;
Daniels, DF ;
Giles, S ;
Fox, S .
CRITICAL CARE, 2005, 9 (06) :R764-R770
[9]   Proactive rounding by the rapid response team reduces inpatient cardiac arrests [J].
Guirgis, Faheem W. ;
Gerdik, Cynthia ;
Wears, Robert L. ;
Williams, Deborah J. ;
Kalynych, Colleen J. ;
Sabato, Joseph ;
Godwin, Steven A. .
RESUSCITATION, 2013, 84 (12) :1668-1673
[10]  
Hall Margaret Jean, 2011, NCHS Data Brief, P1