Mittal Yash, Sankar Jhuma, Dhochak Nitin, Gupta Samriti, Lodha Rakesh, Kabra Sushil Kumar
J Healthc Qual. 2019 Jan/Feb;41(1):32-38. doi: 10.1097/JHQ.0000000000000141.
To measure difference in median time to antibiotic administration in severe sepsis before and after making process changes and clinical outcomes such as duration of hospitalization and mortality.
The study was carried out in the emergency department in children <17 years of age with severe sepsis/septic shock. In phase 1, data were collected and reasons for delayed antibiotic administration were identified. Following this, process changes like creating a triage tool, re-enforcing the severe sepsis protocol and increasing the number of nurses were made to correct the delay. In phase 2, we measured outcomes to compare the effect of the process changes.
A total of 28 and 13 children each were included during phase 1 and phase 2 of the study respectively. The median interquartile range time to administration of antibiotics from the time of admission decreased significantly from 50 minutes (18, 65) to 20 minutes (15, 20) (p = .02). Duration of hospital stay was longer in phase 1 as compared to phase 2 (12 days vs. 6 days). However, the difference was not statistically significant (p = .1).
Use of a triage tool, severe sepsis protocol, and increasing the number of nurses resulted in earlier recognition and administration of first dose of antibiotics in children with severe sepsis.
测量在流程改变前后，严重脓毒症患者抗生素给药的中位时间差异，以及诸如住院时间和死亡率等临床结局。
本研究在17岁以下患有严重脓毒症/脓毒性休克的儿童急诊科中进行。在第1阶段，收集数据并确定抗生素给药延迟的原因。在此之后，进行了流程改变，如创建分诊工具、强化严重脓毒症治疗方案并增加护士数量，以纠正延迟情况。在第2阶段，我们测量结局以比较流程改变的效果。
本研究的第1阶段和第2阶段分别纳入了28名和13名儿童。从入院到抗生素给药的中位四分位间距时间从50分钟（18，65）显著降至20分钟（15，20）（p = .02）。与第2阶段相比，第1阶段的住院时间更长（12天对6天）。然而，差异无统计学意义（p = .1）。
使用分诊工具、严重脓毒症治疗方案以及增加护士数量，使得严重脓毒症儿童能够更早地识别并给予首剂抗生素。
