BMJ Qual Saf. 2014 Dec;23(12):e2. doi: 10.1136/bmjqs-2013-002176.
Antibiotic administration to inpatients developing sepsis in general hospital wards was frequently delayed. We aimed to reproduce improvements in sepsis management reported in other settings.
Ninewells Hospital, an 860-bed teaching hospital with quality improvement (QI) experience, in Scotland, UK. The intervention wards were 22 medical, surgical and orthopaedic inpatient wards.
A multifaceted intervention, informed by baseline process data and questionnaires and interviews with junior doctors, evaluated using segmented regression analysis of interrupted time series (ITS) data. MEASURES FOR IMPROVEMENT: Primary outcome measure: antibiotic administration within 4 hours of sepsis onset. Secondary measures: antibiotics within 8 hours; mean and median time to antibiotics; medical review within 30 min for patients with a standardised early warning system score .4; blood cultures taken before antibiotic administration; blood lactate level measured.
The intervention included printed and electronic clinical guidance, educational clinical team meetings including baseline performance data, audit and monthly feedback on performance.
Performance against all study outcome measures improved postintervention but differences were small and ITS analysis did not attribute the observed changes to the intervention.
Rigorous analysis of this carefully designed improvement intervention could not confirm significant effects. Statistical analysis of many such studies is inadequate, and there is insufficient reporting of negative studies. In light of recent evidence, involving senior clinical team members in verbal feedback and action planning may have made the intervention more effective. Our focus on rigorous intervention design and evaluation was at the expense of iterative refinement, which likely reduced the effect. This highlights the necessary, but challenging, requirement to invest in all three components for effective QI.
在综合医院病房中，住院患者发生脓毒症时，给予抗生素治疗经常会延迟。我们旨在再现其他环境中报告的脓毒症管理方面的改善。
英国苏格兰 860 张病床的教学医院 Ninewells 医院具有质量改进（QI）经验。干预病房为 22 间内科、外科和矫形外科住院病房。
一项多方面的干预措施，基于基线过程数据以及对初级医生的问卷调查和访谈，使用分段回归分析中断时间序列（ITS）数据进行评估。
主要结局指标：脓毒症发作后 4 小时内给予抗生素。次要指标：8 小时内给予抗生素；给予抗生素的平均和中位数时间；对于标准早期预警系统评分≥4 的患者，在 30 分钟内进行医学评估；在给予抗生素前采集血培养；测量血乳酸水平。
干预措施包括印刷和电子临床指南、教育性临床团队会议，包括基线绩效数据、审计以及每月对绩效的反馈。
所有研究结局指标的表现均在干预后得到改善，但差异较小，ITS 分析并未将观察到的变化归因于干预措施。
对这项精心设计的改进干预措施进行严格分析，无法确认其具有显著效果。对许多此类研究的统计分析不足，而且对阴性研究的报道不足。鉴于最近的证据，让高级临床团队成员参与口头反馈和行动计划可能会使干预措施更加有效。我们对严格的干预设计和评估的关注，牺牲了迭代改进，这可能降低了效果。这突显了在有效的 QI 中必须投入资源的必要性，但也具有挑战性。
