Department of Pharmacy, Barnes-Jewish Hospital, and the Pulmonary and Critical Care Division, Washington University School of Medicine, St Louis, MO, USA.
Crit Care Med. 2011 Mar;39(3):469-73. doi: 10.1097/CCM.0b013e318205df85.
Early therapy of sepsis involving fluid resuscitation and antibiotic administration has been shown to improve patient outcomes. A proactive tool to identify patients at risk for developing sepsis may decrease time to interventions and improve patient outcomes. The objective of this study was to evaluate whether the implementation of an automated sepsis screening and alert system facilitated early appropriate interventions.
Prospective, observational, pilot study.
Six medicine wards in Barnes-Jewish Hospital, a 1250-bed academic medical center.
Patients identified by the sepsis screen while admitted to a medicine ward were included in the study. A total of 300 consecutive patients were identified comprising the nonintervention group (n=200) and the intervention group (n=100).
A real-time sepsis alert was implemented for the intervention group, which notified the charge nurse on the patient's hospital ward by text page.
Within 12 hrs of the sepsis alert, interventions by the treating physicians were assessed, including new or escalated antibiotics, intravenous fluid administration, oxygen therapy, vasopressors, and diagnostic tests. After exclusion of patients without commitment to aggressive management, 181 patients in the nonintervention group and 89 patients in the intervention group were analyzed. Within 12 hrs of the sepsis alert, 70.8% of patients in the intervention group had received≥1 intervention vs. 55.8% in the nonintervention group (p=.018). Antibiotic escalation, intravenous fluid administration, oxygen therapy, and diagnostic tests were all increased in the intervention group. This was a single-center, institution- and patient-specific algorithm.
The sepsis alert developed at Barnes-Jewish Hospital was shown to increase early therapeutic and diagnostic interventions among nonintensive care unit patients at risk for sepsis.
早期治疗脓毒症，包括液体复苏和抗生素治疗，已被证明可以改善患者的预后。一种主动识别发生脓毒症风险的患者的工具可能会缩短干预时间，改善患者的预后。本研究的目的是评估实施自动化脓毒症筛查和警报系统是否有助于早期进行适当的干预。
前瞻性、观察性、试点研究。
巴恩斯-犹太医院的六个内科病房，这是一家拥有 1250 张床位的学术医疗中心。
在内科病房住院时被脓毒症筛查识别的患者被纳入研究。共有 300 名连续患者被确定为非干预组（n=200）和干预组（n=100）。
为干预组实施实时脓毒症警报，通过文本页面通知患者所在医院病房的值班护士。
在脓毒症警报后 12 小时内，评估了主治医生的干预措施，包括新的或升级的抗生素、静脉补液、氧疗、血管加压药和诊断性检查。排除无积极管理意愿的患者后，分析了非干预组的 181 名患者和干预组的 89 名患者。在脓毒症警报后 12 小时内，干预组 70.8%的患者接受了≥1 项干预，而非干预组为 55.8%（p=.018）。干预组中抗生素升级、静脉补液、氧疗和诊断性检查均增加。这是一项单中心、机构和患者特异性的算法。
巴恩斯-犹太医院开发的脓毒症警报系统被证明可以增加有脓毒症风险的非重症监护病房患者的早期治疗和诊断干预。
