Memorial Hospital of Rhode Island, Brown University, 111 Brewster Street, Pawtucket, RI 02860, USA.
Lung. 2011 Feb;189(1):11-9. doi: 10.1007/s00408-010-9266-z. Epub 2010 Nov 16.
The objective of this prospective cohort study was to see the effect of the implementation of a Sepsis Intervention Program on the standard processes of patient care using a collaborative approach between the Emergency Department (ED) and Medical Intensive Care Unit (MICU). This was performed in a large urban tertiary-care hospital, with no previous experience utilizing a specific intervention program as routine care for septic shock and which has services and resources commonly available in most hospitals. The study included 106 patients who presented to the ED with severe sepsis or septic shock. Eighty-seven of those patients met the inclusion criteria for complete data analysis. The ED and MICU staff underwent a 3-month training period followed by implementation of a protocol for sepsis intervention program over 6 months. In the first 6 months of the program's implementation, 106 patients were admitted to the ED with severe sepsis and septic shock. During this time, the ED attempted to initiate the sepsis intervention protocol in 76% of the 87 septic patients who met the inclusion criteria. This was assessed by documentation of a central venous catheter insertion for continuous SvO(2) monitoring in a patient with sepsis or septic shock. However, only 48% of the eligible patients completed the early goal-directed therapy (EGDT) protocol. Our data showed that the in-hospital mortality rate was 30.5% for the 87 septic shock patients with a mean APACHE II score of 29. This was very similar to a landmark study of EGDT (30.5% mortality with mean APACHE II of 21.5). Data collected on processes of care showed improvements in time to fluid administration, central venous access insertion, antibiotic administration, vasopressor administration, and time to MICU transfer from ED arrival in our patients enrolled in the protocol versus those who were not. Further review of our performance data showed that processes of care improved steadily the longer the protocol was in effect, although this was not statistically significant. There was no improvement in secondary outcomes, including total length of hospital stay, MICU days, and mortality. Implementation of a sepsis intervention program as a standard of care in a typical hospital protocol leads to improvements in processes of care. However, despite a collaborative approach, the sepsis intervention program was underutilized with only 48% of the patients completing the sepsis intervention protocol.
这项前瞻性队列研究的目的是观察采用急诊部（ED）和内科重症监护病房（MICU）之间的协作方法实施脓毒症干预方案对患者护理标准流程的影响。该研究在一家大型城市三级保健医院进行，该医院以前没有使用特定干预方案作为脓毒性休克常规护理的经验，但拥有大多数医院都具备的服务和资源。该研究纳入了 106 例因严重脓毒症或脓毒性休克就诊于 ED 的患者。其中 87 例符合完整数据分析的纳入标准。ED 和 MICU 工作人员接受了为期 3 个月的培训，随后在 6 个月的时间里实施了脓毒症干预方案的方案。在该方案实施的前 6 个月中，有 106 例严重脓毒症和脓毒性休克患者被收治到 ED。在此期间，ED 试图在符合纳入标准的 87 例脓毒症患者中启动脓毒症干预方案的 76%。这通过在脓毒症或脓毒性休克患者中记录中央静脉导管插入以进行连续 SvO2 监测来评估。然而，只有 48%的合格患者完成了早期目标导向治疗（EGDT）方案。我们的数据显示，在 87 例脓毒性休克患者中，院内死亡率为 30.5%，平均急性生理学和慢性健康评估 II 评分（APACHE II）为 29。这与 EGDT 的一项里程碑式研究非常相似（死亡率为 30.5%，平均 APACHE II 为 21.5）。在纳入方案的患者中，与未纳入方案的患者相比，在护理过程数据上显示出在液体给药、中心静脉通路插入、抗生素给药、血管加压素给药和从 ED 到达 MICU 转移的时间方面有所改善。对我们的绩效数据进行进一步审查后发现，尽管没有统计学意义，但随着方案的实施时间延长，护理过程不断得到改善。次要结局，包括总住院时间、MICU 天数和死亡率均无改善。在典型的医院方案中，将脓毒症干预方案作为常规护理标准实施可改善护理过程。然而，尽管采用了协作方法，但由于只有 48%的患者完成了脓毒症干预方案，因此该方案的使用率较低。
