From the Departments of Surgery (C.A.C., F.A.M., P.A.E., L.L., J.J., V.K., R.M.S., B.A.M.) and Anesthesiology (A.G.), College of Medicine, University of Florida; and Trauma ICU (P.S.M.) and Surgery ICU (L.S.W.), UFHealth, Shands Hospital Gainesville, Florida.
J Trauma Acute Care Surg. 2014 Feb;76(2):311-7; discussion 318-9. doi: 10.1097/TA.0000000000000121.
A system to provide surveillance, diagnosis, and protocolized management of surgical intensive care unit (SICU) sepsis was undertaken as a performance improvement project. A system for sepsis management was implemented for SICU patients using paper followed by a computerized system. The hypothesis was that the computerized system would be associated with improved process and outcomes.
A system was designed to provide early recognition and guide patient-specific management of sepsis including (1) modified early warning signs-sepsis recognition score (MEWS-SRS; summative point score of ranges of vital signs, mental status, white blood cell count; after every 4 hours) by bedside nurse; (2) suspected site assessment (vascular access, lung, abdomen, urinary tract, soft tissue, other) at bedside by physician or extender; (3) sepsis management protocol (replicable, point-of-care decisions) at bedside by nurse, physician, and extender. The system was implemented first using paper and then a computerized system. Sepsis severity was defined using standard criteria.
In January to May 2012, a paper system was used to manage 77 consecutive sepsis encounters (3.9 ± 0.5 cases per week) in 65 patients (77% male; age, 53 ± 2 years). In June to December 2012, a computerized system was used to manage 132 consecutive sepsis encounters (4.4 ± 0.4 cases per week) in 119 patients (63% male; age, 58 ± 2 years). MEWS-SRS elicited 683 site assessments, and 201 had sepsis diagnosis and protocol management. The predominant site of infection was abdomen (paper, 58%; computer, 53%). Recognition of early sepsis tended to occur more using the computerized system (paper, 23%; computer, 35%). Hospital mortality rate for surgical ICU sepsis (paper, 20%; computer, 14%) was less with the computerized system.
A computerized sepsis management system improves care process and outcome. Early sepsis is recognized and managed with greater frequency compared with severe sepsis or septic shock. The system has a beneficial effect as a clinical standard of care for SICU patients.
Therapeutic study, level III.
作为一项绩效改进项目，建立了一个监测、诊断和规范化管理外科重症监护病房（SICU）脓毒症的系统。为 SICU 患者使用纸质系统和计算机系统实施了脓毒症管理系统。假设计算机系统将与改善过程和结果相关。
设计了一个系统，以提供脓毒症的早期识别和指导患者的具体管理，包括（1）由床边护士进行改良早期预警评分-脓毒症识别评分（MEWS-SRS；生命体征、精神状态、白细胞计数的范围总和评分；每 4 小时一次）；（2）由医生或助理在床边进行疑似部位评估（血管通路、肺部、腹部、尿路、软组织、其他）；（3）由护士、医生和助理在床边进行脓毒症管理方案（可复制、即时决策）。该系统首先使用纸质系统，然后使用计算机系统。使用标准标准定义脓毒症的严重程度。
2012 年 1 月至 5 月，使用纸质系统管理了 65 例患者中 77 例连续脓毒症患者（每周 3.9 ± 0.5 例）（男性 77%；年龄 53 ± 2 岁）。2012 年 6 月至 12 月，使用计算机系统管理了 119 例患者中 132 例连续脓毒症患者（每周 4.4 ± 0.4 例）（男性 63%；年龄 58 ± 2 岁）。MEWS-SRS 共进行了 683 次部位评估，201 次有脓毒症诊断和方案管理。感染的主要部位是腹部（纸质系统 58%；计算机系统 53%）。使用计算机系统更容易早期发现脓毒症（纸质系统 23%；计算机系统 35%）。SICU 脓毒症的医院死亡率（纸质系统 20%；计算机系统 14%）使用计算机系统较低。
计算机化脓毒症管理系统改善了护理过程和结果。与严重脓毒症或脓毒性休克相比，早期脓毒症的识别和管理更为频繁。该系统作为 SICU 患者的临床护理标准具有有益的效果。
治疗研究，III 级。
