评估急诊科脓毒症治疗流程的实施情况及效果。

Evaluating the implementation and outcomes of a sepsis pathway in the emergency department.

作者信息

Pouryahya Pourya, Guiney Natalie, Meyer Alastair, Goldie Neil

机构信息

Casey Hospital, Emergency Department, Programme of Emergency Medicine, Monash Health, Victoria; Monash Emergency Research Collaborative, School of Clinical Sciences, Monash Health, Monash University, Victoria; Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria.

Bendigo Health, Victoria.

出版信息

N Z Med J. 2020 Aug 21;133(1520):35-49.

PMID:32994592

Abstract

AIM

Early recognition and timely management, including prompt administration of antibiotics, has been fundamental in improving the mortality related to sepsis. We aimed to study the effect of the Sepsis Pathway Programme, a set of guidelines for sepsis, on the recognition, early investigation and management of septic patients in the emergency department.

METHODS

We conducted a comparative prospective cohort study of patients who presented with suspected sepsis pre- and post-implementation of the Sepsis Pathway. Patients where the Sepsis Pathway was used were identified and followed prospectively to analyse outcomes. This group was compared to a pre-intervention control group who were identified retrospectively before the Sepsis Pathway was implemented to determine if there was any difference in outcomes.

RESULTS

A total of 109 patients were identified to be septic in the emergency department following the implementation of the Sepsis Pathway. Of these, 52 cases involved the initiation and completion of the Sepsis Pathway. One hundred and fifty-seven cases were identified in the pre-intervention group of which 18 cases were excluded. The time to antibiotic administration decreased from 182 to 75 minutes (p<0.00001). The proportion of cases where antibiotics were given within the hour was higher in the pathway group (36.5% vs 8.6%, OR 6.09, 95% CI 2.69-13.81, p<0.0001). Similarly, the time to lactate measurement decreased from 64 minutes to 54.5 minutes (p=0.0117) and the proportion of cases where lactate was measured improved from 64% to 92.3% (p=0.0005). Blood culture rates improved from 79.1% to 100%.

CONCLUSION

The implementation of the Sepsis Pathway improved time taken to perform investigations and manage patients with sepsis. Although it had improved, there was still a delay in recognition of sepsis and initiation of investigations and management, demonstrating that further strategies need to be employed to reduce poor outcomes associated with sepsis. However, it did not affect ICU admissions, length of stay or mortality.

摘要

目的

早期识别和及时处理，包括迅速给予抗生素，一直是改善脓毒症相关死亡率的根本措施。我们旨在研究脓毒症诊疗路径计划（一套脓毒症诊疗指南）对急诊科脓毒症患者的识别、早期检查及处理的影响。

方法

我们对脓毒症诊疗路径实施前后出现疑似脓毒症的患者进行了一项比较性前瞻性队列研究。确定使用脓毒症诊疗路径的患者并进行前瞻性随访以分析结果。将该组与脓毒症诊疗路径实施前回顾性确定的干预前对照组进行比较，以确定结果是否存在差异。

结果

脓毒症诊疗路径实施后，急诊科共识别出109例脓毒症患者。其中，52例涉及脓毒症诊疗路径的启动和完成。干预前组识别出157例，其中18例被排除。抗生素给药时间从182分钟降至75分钟（p<0.00001）。脓毒症诊疗路径组在1小时内给予抗生素的病例比例更高（36.5%对8.6%，OR 6.09，95%CI 2.69-13.81，p<0.0001）。同样，乳酸测量时间从64分钟降至54.5分钟（p=0.0117），测量乳酸的病例比例从64%提高到92.3%（p=0.0005）。血培养率从79.1%提高到100%。