Jt Comm J Qual Patient Saf. 2020 May;46(5):299-307. doi: 10.1016/j.jcjq.2020.02.005. Epub 2020 Feb 21.
Sepsis is a leading cause of pediatric mortality worldwide. The implementation of sepsis bundles and clinical decision support (CDS) tools have been useful in improving sepsis recognition and treatment.
Interventions targeted the pediatric ICU (PICU) sepsis identification process and focused on implementation of multidisciplinary sepsis huddles prompted by an automated CDS tool. The primary outcome measure was days between delayed sepsis recognition, with secondary outcome measures of the percentages of patients receiving goal-directed evidence-based sepsis therapies, including antibiotics within 1 hour, rapid fluid bolus within 20 minutes, and lactate measurement within 1 hour. The researchers also tracked median time to antibiotics.
Average days between delayed sepsis recognition improved from one episode every 9 days to one episode every 28 days. The percentage of patients who received antibiotics within 1 hour improved from 33.9% to 45.5%, received a fluid bolus within 20 minutes increased from 54.7% to 61.8%, and had a lactate measured within 1 hour increased from 59.4% to 71.1% post-CDS alert; none were statistically significant. Median time to antibiotics prior to CDS alert implementation was 1.53 hours, with improvement to 1.05 hours postimplementation (p = 0.03).
Implementation of multidisciplinary sepsis huddles and an automated CDS alert in the PICU led to an improvement in days between delayed sepsis recognition and a significant improvement in time to antibiotics.
败血症是全球儿童死亡的主要原因。实施败血症套餐和临床决策支持（CDS）工具对于提高败血症的识别和治疗效果非常有用。
干预措施针对儿科重症监护病房（PICU）的败血症识别过程，并侧重于通过自动化 CDS 工具提示实施多学科败血症讨论。主要观察指标为延迟性败血症识别之间的天数，次要观察指标为接受目标导向循证败血症治疗的患者比例，包括在 1 小时内使用抗生素、在 20 分钟内快速补液和在 1 小时内测量乳酸盐。研究人员还跟踪了抗生素的中位数时间。
平均延迟性败血症识别天数从每 9 天出现 1 例改善至每 28 天出现 1 例。在 1 小时内接受抗生素的患者比例从 33.9%提高至 45.5%，在 20 分钟内接受液体冲击的患者比例从 54.7%提高至 61.8%，在 1 小时内测量乳酸盐的患者比例从 59.4%提高至 71.1%；这些均无统计学意义。在实施 CDS 警报之前，使用抗生素的中位数时间为 1.53 小时，实施后改善至 1.05 小时（p=0.03）。
在 PICU 中实施多学科败血症讨论和自动化 CDS 警报，可改善延迟性败血症识别之间的天数，并显著改善抗生素使用时间。
