Romero Bernadine, Fry Margaret, Roche Michael
Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
Emergency Department St George Hospital, South Eastern Sydney Local Health District, Kogarah, NSW, Australia.
J Clin Nurs. 2017 Nov;26(21-22):3588-3596. doi: 10.1111/jocn.13728. Epub 2017 Apr 7.
To explore the number of patients presenting with sepsis before and after guideline implementation; the impact of sepsis guidelines on triage assessment, emergency department management and time to antibiotics.
Sepsis remains one of the leading causes of mortality and morbidity within hospitals. Globally, strategies have been implemented to reduce morbidity and mortality rates, which rely on the early recognition and management of sepsis. To improve patient outcomes, the New South Wales government in Australia introduced sepsis guidelines into emergency departments. However, the impact of the guidelines on clinical practice remains unclear.
DESIGN/METHODS: A 12-month pre-post retrospective randomised medical record audit of adult patients with a sepsis diagnosis. Data were extracted from the emergency department database and paper medical record. Data included patient demographic (age, gender), clinical information (time of arrival, triage code, seen by time, disposition, time to antibiotic, pathology, time to intravenous fluids) and patient assessment data (heart rate, respiratory rate, blood pressure, temperature, oxygen saturations, medication).
This study demonstrated a statistically significant 230-minute reduction in time to antibiotics post implementation of the guidelines. The post group (n = 165) received more urgent triage categories (n = 81; 49·1%), a 758-minute reduction in mean time to second litre of intravenous fluids and an improvement in collection of lactate (n = 112, 67·9%), also statistically significant.
The findings highlight the impact the guidelines can have on clinician decision-making and behaviour that support best practice and positive patient outcomes. The sepsis guidelines improved the early assessment, recognition and management of patients presenting with sepsis in one tertiary referral emergency department.
The use of evidenced-based guidelines can impact clinical decision-making and behaviour, resulting in the translation and support of best practice and improving patient care.
探讨指南实施前后脓毒症患者的数量；脓毒症指南对分诊评估、急诊科管理及使用抗生素时间的影响。
脓毒症仍是医院内导致死亡和发病的主要原因之一。在全球范围内，已实施了旨在降低发病率和死亡率的策略，这些策略依赖于对脓毒症的早期识别和管理。为改善患者预后，澳大利亚新南威尔士州政府在急诊科引入了脓毒症指南。然而，这些指南对临床实践的影响仍不明确。
设计/方法：对确诊为脓毒症的成年患者进行为期12个月的前后回顾性随机病历审核。数据从急诊科数据库和纸质病历中提取。数据包括患者人口统计学信息（年龄、性别）、临床信息（到达时间、分诊代码、就诊时间、处置情况、使用抗生素时间、病理检查、开始静脉输液时间）以及患者评估数据（心率、呼吸频率、血压、体温、血氧饱和度、用药情况）。
本研究表明，指南实施后使用抗生素的时间在统计学上显著缩短了230分钟。后一组（n = 165）接受了更紧急的分诊类别（n = 81；49.1%），平均第二升静脉输液时间缩短了758分钟，乳酸采集情况有所改善（n = 112，67.9%），这些也都具有统计学意义。
研究结果凸显了指南对临床医生决策和行为的影响，这些影响有助于支持最佳实践和实现积极的患者预后。脓毒症指南改善了一家三级转诊急诊科中脓毒症患者的早期评估、识别和管理。
使用循证指南可影响临床决策和行为，从而转化并支持最佳实践，改善患者护理。
