Deisz Robert, Rademacher Susanne, Gilger Katrin, Jegen Rudolf, Sauerzapfe Barbara, Fitzner Christina, Stoppe Christian, Benstoem Carina, Marx Gernot
Department of Intensive Care Medicine, Medical Faculty RWTH Aachen, University Hospital RWTH Aachen, Aachen, Germany.
Department of Anaesthesiology, St. Elisabeth Hospital, Jülich, Germany.
J Med Internet Res. 2019 Jan 15;21(1):e11161. doi: 10.2196/11161.
Sepsis is a major health care problem with high morbidity and mortality rates and affects millions of patients. Telemedicine, defined as the exchange of medical information via electronic communication, improves the outcome of patients with sepsis and decreases the mortality rate and length of stay in the intensive care unit (ICU). Additional telemedicine rounds could be an effective component of performance-improvement programs for sepsis, especially in underserved rural areas and hospitals without ready access to critical care physicians.
Our aim was to evaluate the impact of additional daily telemedicine rounds on adherence to sepsis bundles. We hypothesized that additional telemedicine support may increase adherence to sepsis guidelines and improve the detection rates of sepsis and septic shock.
We conducted a retrospective, observational, multicenter study between January 2014 and July 2015 with one tele-ICU center and three ICUs in Germany. We implemented telemedicine as part of standard care and collected data continuously during the study. During the daily telemedicine rounds, routine screening for sepsis was conducted and adherence to the Surviving Sepsis Campaign's 3-hour and 6-hour sepsis bundles were evaluated.
In total, 1168 patients were included in this study, of which 196 were positive for severe sepsis and septic shock. We found that additional telemedicine rounds improved adherence to the 3-hour (Quarter 1, 35% vs Quarter 6, 76.2%; P=.01) and 6-hour (Quarter 1, 50% vs Quarter 6, 95.2%; P=.001) sepsis bundles. In addition, we noted an increase in adherence to the item "Administration of fluids when hypotension" (Quarter 1, 80% vs Quarter 6, 100%; P=.049) of the 3-hour bundle and the item "Remeasurement of lactate" (Quarter 1, 65% vs Quarter 6, 100%, P=.003) of the 6-hour bundle. The ICU length of stay after diagnosis of severe sepsis and septic shock remained unchanged over the observation period. Due to a higher number of patients with sepsis in Quarter 5 (N=60) than in other quarters, we observed stronger effects of the additional rounds on mortality in this quarter (Quarter 1, 50% vs Quarter 5, 23.33%, P=.046).
Additional telemedicine rounds are an effective component of and should be included in performance-improvement programs for sepsis management.
脓毒症是一个主要的医疗保健问题，发病率和死亡率很高，影响着数百万患者。远程医疗定义为通过电子通信交换医疗信息，可改善脓毒症患者的治疗结果，降低死亡率，并缩短重症监护病房（ICU）的住院时间。额外的远程医疗查房可能是脓毒症质量改进项目的一个有效组成部分，特别是在农村地区医疗服务不足以及无法随时获得重症监护医生的医院。
我们的目的是评估每日额外的远程医疗查房对脓毒症集束治疗依从性的影响。我们假设额外的远程医疗支持可能会提高对脓毒症指南的依从性，并提高脓毒症和感染性休克的检出率。
我们在2014年1月至2015年7月期间进行了一项回顾性、观察性、多中心研究，研究对象为德国的一个远程ICU中心和三个ICU。我们将远程医疗作为标准治疗的一部分实施，并在研究期间持续收集数据。在每日的远程医疗查房期间，对脓毒症进行常规筛查，并评估对“拯救脓毒症运动”3小时和6小时脓毒症集束治疗的依从性。
本研究共纳入1168例患者，其中196例严重脓毒症和感染性休克检测呈阳性。我们发现，额外的远程医疗查房提高了对3小时（第1季度，35%对第6季度，76.2%；P = 0.01）和6小时（第1季度，50%对第6季度，95.2%；P = 0.001）脓毒症集束治疗的依从性。此外，我们注意到3小时集束治疗中“低血压时给予液体”这一项（第1季度，80%对第6季度，100%；P = 0.049）以及6小时集束治疗中“重新测量乳酸水平”这一项（第1季度，65%对第6季度，100%，P = 0.003）的依从性有所提高。在观察期内，诊断为严重脓毒症和感染性休克后的ICU住院时间保持不变。由于第5季度脓毒症患者数量（N = 60）多于其他季度，我们观察到该季度额外查房对死亡率的影响更强（第1季度，50%对第5季度，23.33%，P = 0.046）。
额外的远程医疗查房是脓毒症管理质量改进项目的一个有效组成部分，应纳入其中。
