Hung K Kc, Lam R Pk, Lo R Sl, Tenney J W, Yang M Lc, Tai M Ck, Graham C A
Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, Hong Kong.
Accident and Emergency Department, Prince of Wales Hospital, Shatin, Hong Kong.
Hong Kong Med J. 2018 Dec;24(6):571-578. doi: 10.12809/hkmj177149. Epub 2018 Nov 14.
Emergency departments (EDs) play an important role in the early identification and management of sepsis. Little is known about local EDs' processes of care for sepsis, adoption of international recommendations, and the impact of the new Sepsis-3 definitions.
Structured telephone interviews based on the United Kingdom Sepsis Trust 'Exemplar Standards for the Emergency Management of Sepsis' were conducted from January to August 2017 with nominated representatives of all responding public hospital EDs in Hong Kong, followed by a review of hospital/departmental sepsis guidelines by the investigators.
Sixteen of the 18 public EDs in Hong Kong participated in the study. Among various time-critical medical emergencies such as major trauma, sepsis was perceived by the interviewees to be the leading cause of in-hospital mortality and the second most important preventable cause of death. However, only seven EDs reported having departmental guidelines on sepsis care, with four adopting the Quick Sequential Organ Failure Assessment score or its modified versions. All responding EDs reported that antibiotics were stocked within their departments, and all EDs with sepsis guidelines mandated early intravenous antibiotic administration within 1 to 2 hours of detection. Reported major barriers to optimal sepsis care included lack of knowledge and experience, nursing human resources shortages, and difficulty identifying patients with sepsis in the ED setting.
There are considerable variations in sepsis care among EDs in Hong Kong. More training, resources, and research efforts should be directed to early ED sepsis care, to improve patient outcomes.
急诊科在脓毒症的早期识别和管理中发挥着重要作用。对于当地急诊科脓毒症的护理流程、国际建议的采用情况以及新的脓毒症-3定义的影响，人们了解甚少。
2017年1月至8月，根据英国脓毒症信托基金的“脓毒症应急管理示范标准”，对香港所有做出回应的公立医院急诊科的指定代表进行了结构化电话访谈，随后研究人员对医院/科室的脓毒症指南进行了审查。
香港18家公立急诊科中有16家参与了该研究。在重大创伤等各种时间紧迫的医疗紧急情况中，受访者认为脓毒症是院内死亡的主要原因，也是第二大重要的可预防死亡原因。然而，只有7家急诊科报告有脓毒症护理的科室指南，其中4家采用了快速序贯器官衰竭评估评分或其修改版本。所有做出回应的急诊科均报告称其科室备有抗生素，所有有脓毒症指南的急诊科都规定在检测到脓毒症后1至2小时内尽早静脉注射抗生素。据报告，脓毒症最佳护理的主要障碍包括知识和经验不足、护理人力资源短缺以及在急诊科环境中难以识别脓毒症患者。
香港各急诊科在脓毒症护理方面存在很大差异。应将更多的培训、资源和研究工作导向急诊科脓毒症的早期护理，以改善患者预后。
