Department of Emergency Medicine, Calgary Health Region, Calgary, Alberta, Canada.
CJEM. 2010 Jul;12(4):303-10. doi: 10.1017/s1481803500012380.
We sought to evaluate the time to antibiotics for emergency department (ED) patients meeting criteria for severe sepsis before and after the implementation of an ED sepsis protocol. Compliance with published guidelines for time to antibiotics and initial empiric therapy in sepsis was also assessed.
A retrospective chart review was conducted. Emergency department patient encounters with International Classification of Diseases codes related to severe infections were screened during a 3-month period before and after the implementation of a sepsis protocol. Encounters meeting criteria for severe sepsis were further assessed. The time to initiation of antibiotics was determined as well as the initial choice of antimicrobial therapy based on the presumed source of infection.
We reviewed 213 unique ED patient encounters meeting criteria for severe sepsis. Analysis of the period before implementation showed a median time from the time criteria for severe sepsis were met to delivery of antibiotics of 163 minutes (95% confidence interval [CI] 124 to 210 min). Analysis of the period after implementation of the protocol revealed a median time of 79 minutes (95% CI 64 to 94 min), representing an overall reduction of 84 minutes (95% CI 42 to 126 min). Before the implementation of the protocol, 47% of patients received correct antibiotic coverage for the presumed source of infection in compliance with locally published guidelines. After the initiation of the protocol, 73% received appropriate initial antibiotics, for an overall improvement of 26%.
A guideline-based ED sepsis protocol for the evaluation and treatment of the septic patient appears to improve the time to administration of antibiotics as well as the appropriateness of initial antibiotic therapy in patients with severe sepsis.
我们旨在评估符合严重脓毒症标准的急诊科（ED）患者在实施 ED 脓毒症方案前后使用抗生素的时间。还评估了在脓毒症中使用抗生素和初始经验性治疗的时间符合已发表指南的情况。
回顾性图表审查。在实施脓毒症方案前和后 3 个月期间，筛选国际疾病分类编码与严重感染相关的 ED 患者就诊。进一步评估符合严重脓毒症标准的就诊。确定开始使用抗生素的时间以及根据假定感染源选择初始经验性治疗的抗菌药物。
我们回顾了 213 例符合严重脓毒症标准的独特 ED 患者就诊。在实施前的时间段分析中，从符合严重脓毒症标准到使用抗生素的中位数时间为 163 分钟（95%置信区间 [CI] 124 至 210 分钟）。分析方案实施后的时间段，中位数时间为 79 分钟（95% CI 64 至 94 分钟），总体减少 84 分钟（95% CI 42 至 126 分钟）。在实施方案之前，47%的患者根据当地发表的指南接受了针对假定感染源的正确抗生素覆盖。在方案启动后，73%的患者接受了适当的初始抗生素治疗，总体改善了 26%。
基于指南的 ED 脓毒症方案似乎可改善对脓毒症患者的评估和治疗，从而缩短抗生素使用时间，并提高严重脓毒症患者初始抗生素治疗的适宜性。
