计算机与纸质系统在外科重症监护中用于脓毒症的识别和管理。

Computer versus paper system for recognition and management of sepsis in surgical intensive care.

机构信息

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.

出版信息

J Trauma Acute Care Surg. 2014 Feb;76(2):311-7; discussion 318-9. doi: 10.1097/TA.0000000000000121.

DOI:10.1097/TA.0000000000000121

PMID:24458039

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

LEVEL OF EVIDENCE

Therapeutic study, level III.

摘要

背景

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。

方法

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。

结果

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。