Barker Nicholas, Scott Ian A, Seaton Robert, Mehta Naitik, Kalke Vikrant R, Redpath Lyndell
Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Patient Quality and Safety Improvement Service, Queensland Health, Brisbane, Australia.
Int J Gen Med. 2023 Mar 21;16:1039-1046. doi: 10.2147/IJGM.S400839. eCollection 2023.
To assess accuracy of early diagnosis, appropriateness and timeliness of response, and clinical outcomes of older general medical inpatients with hospital-acquired sepsis.
Hospital abstracts of inpatient encounters from seven digital Queensland public hospitals between July 2018 and September 2020 were screened retrospectively for diagnoses of hospital-acquired sepsis. Electronic medical records were retrieved and cases meeting selection criteria and classified as confirmed or probable sepsis using pre-specified criteria were included. Investigations and treatments following the first digitally generated alert of clinical deterioration were compared with a best practice sepsis care bundle. Outcome measures comprised 30-day all-cause mortality after deterioration, and unplanned readmissions at 14 days after discharge.
Of the 169 screened care episodes, 59 comprised probable or confirmed cases of sepsis treated by general medicine teams at the time of initial deterioration. Of these, 43 (72.9%) had no mention of sepsis in the differential diagnosis on first medical review, and only 38 (64%) were managed as having sepsis. Each care bundle component of blood cultures, serum lactate, and intravenous fluid resuscitation and antibiotics was only delivered in approximately 30% of cases, and antibiotic administration was delayed more than an hour in 28 of 38 (73.7%) cases.
Early recognition of sepsis and timely implementation of care bundles are challenging in older general medical patients. Education programs in sepsis care standards targeting nurses and junior medical staff, closer patient monitoring, and post-discharge follow-up may improve patient outcomes.
评估老年普通内科住院患者医院获得性脓毒症的早期诊断准确性、反应的恰当性和及时性以及临床结局。
回顾性筛查2018年7月至2020年9月期间昆士兰七家数字公立医院的住院患者摘要，以确定医院获得性脓毒症的诊断。检索电子病历，纳入符合选择标准并根据预先指定标准分类为确诊或疑似脓毒症的病例。将首次数字生成的临床恶化警报后的检查和治疗与最佳实践脓毒症护理包进行比较。结局指标包括恶化后30天全因死亡率和出院后14天内的非计划再入院率。
在筛查的169例护理事件中，59例包括普通内科团队在初始恶化时治疗的可能或确诊脓毒症病例。其中，43例（72.9%）在首次医学评估的鉴别诊断中未提及脓毒症，只有38例（64%）按脓毒症进行管理。血培养、血清乳酸、静脉液体复苏和抗生素等每个护理包组成部分仅在约30%的病例中实施，38例中的28例（73.7%）抗生素给药延迟超过1小时。
在老年普通内科患者中，早期识别脓毒症并及时实施护理包具有挑战性。针对护士和初级医务人员的脓毒症护理标准教育计划、更密切的患者监测以及出院后随访可能会改善患者结局。
