Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
BMJ Open Qual. 2021 Jul;10(Suppl 1). doi: 10.1136/bmjoq-2020-001335.
Failure of early identification of sepsis in the emergency department (ED) leads to significant delays in antibiotic administration which adversely affects patient outcomes.
The primary objective of our Quality Improvement (QI) project was to reduce the door-to-antibiotic time (DTAT) by 30% from the preintervention in patients with suspected sepsis. Secondary objectives were to increase the blood culture collection rate by 30% from preintervention, investigate the predictors of improving DTAT and study the effect of these interventions on 24-hour in-hospital mortality.
This QI project was conducted in the ED of a tertiary care teaching hospital of North India; the ED receives approximately 400 patients per day. Adult patients with suspected sepsis presenting to our ED were included in the study, between January 2019 and December 2020. The study was divided into three phases; preintervention phase (100 patients), intervention phase (100 patients) and postintervention phase (93 patients). DTAT and blood cultures prior to antibiotic administration was recorded for all patients. Blood culture yield and 24-hour in-hospital mortality were also recorded using standard data templates. Change ideas planned by the Sepsis QI Team were implemented after conducting plan-do-study-act cycles.
The median DTAT reduced from 155 min in preintervention phase to 78 min in postintervention phase. Drawing of blood cultures prior to antibiotic administration improved by 67%. Application of novel screening tool at triage was found to be an independent predictor of reduced DTAT.
Our QI project identified the existing lacunae in implementation of the sepsis bundle which were dealt with in a stepwise manner. The sepsis screening tool and on-site training improved care of patients with sepsis. A similar approach can be used to deal with complex quality issues in other high-volume low-resource settings.
在急诊科（ED）未能早期识别脓毒症会导致抗生素给药显著延迟，从而对患者预后产生不利影响。
我们的质量改进（QI）项目的主要目标是将疑似脓毒症患者的门到抗生素时间（DTAT）从干预前降低 30%。次要目标是将血培养采集率从干预前提高 30%，调查改善 DTAT 的预测因素，并研究这些干预措施对 24 小时住院内死亡率的影响。
本 QI 项目在印度北部一家三级护理教学医院的 ED 进行；ED 每天接收约 400 名患者。纳入研究的是 2019 年 1 月至 2020 年 12 月期间到我院 ED 就诊的疑似脓毒症的成年患者。该研究分为三个阶段；干预前阶段（100 例患者）、干预阶段（100 例患者）和干预后阶段（93 例患者）。所有患者均记录抗生素给药前的 DTAT 和血培养情况。使用标准数据模板记录血培养产量和 24 小时住院内死亡率。Sepsis QI 团队计划的变更想法在进行计划-执行-研究-行动循环后实施。
干预前阶段的中位 DTAT 从 155 分钟降至干预后阶段的 78 分钟。抗生素给药前采血培养的比例提高了 67%。在分诊时应用新型筛查工具被发现是降低 DTAT 的独立预测因素。
我们的 QI 项目确定了脓毒症包实施中存在的差距，并以逐步的方式加以解决。脓毒症筛查工具和现场培训改善了脓毒症患者的护理。类似的方法可用于处理其他高容量低资源环境中的复杂质量问题。
