Dale Christopher R, Schoepflin Sanders Shelley, Chang Shu Ching, Pandhair Omar, Diggs Naomi G, Woodruff Whitney, Selander David N, Mark Nicholas M, Nurse Sarah, Sullivan Mark, Mezaraups Liga, O'Mahony D Shane
Swedish Health Services, Seattle, WA.
School of Public Health, University of Washington, Seattle, WA.
Crit Care Explor. 2023 May 16;5(5):e0918. doi: 10.1097/CCE.0000000000000918. eCollection 2023 May.
The Surviving Sepsis Campaign recommends standard operating procedures for patients with sepsis. Real-world evidence about sepsis order set implementation is limited.
To estimate the effect of sepsis order set usage on hospital mortality.
Retrospective cohort study.
Fifty-four acute care hospitals in the United States from December 1, 2020 to November 30, 2022 involving 104,662 patients hospitalized for sepsis.
Hospital mortality.
The sepsis order set was used in 58,091 (55.5%) patients with sepsis. Initial mean sequential organ failure assessment score was 0.3 lower in patients for whom the order set was used than in those for whom it was not used (2.9 sd [2.8] vs 3.2 [3.1], < 0.01). In bivariate analysis, hospital mortality was 6.3% lower in patients for whom the sepsis order set was used (9.7% vs 16.0%, < 0.01), median time from emergency department triage to antibiotics was 54 minutes less (125 interquartile range [IQR, 68-221] vs 179 [98-379], < 0.01), and median total time hypotensive was 2.1 hours less (5.5 IQR [2.0-15.0] vs 7.6 [2.5-21.8], < 0.01) and septic shock was 3.2% less common (22.0% vs 25.4%, < 0.01). Order set use was associated with 1.1 fewer median days of hospitalization (4.9 [2.8-9.0] vs 6.0 [3.2-12.1], < 0.01), and 6.6% more patients discharged to home (61.4% vs 54.8%, < 0.01). In the multivariable model, sepsis order set use was independently associated with lower hospital mortality (odds ratio 0.70; 95% CI, 0.66-0.73).
In a cohort of patients hospitalized with sepsis, order set use was independently associated with lower hospital mortality. Order sets can impact large-scale quality improvement efforts.
拯救脓毒症运动推荐了脓毒症患者的标准操作程序。关于脓毒症医嘱集实施的真实世界证据有限。
评估脓毒症医嘱集的使用对医院死亡率的影响。
回顾性队列研究。
2020年12月1日至2022年11月30日期间，美国54家急性护理医院，涉及104,662名因脓毒症住院的患者。
医院死亡率。
58,091名（55.5%）脓毒症患者使用了脓毒症医嘱集。使用医嘱集的患者初始平均序贯器官衰竭评估评分比未使用者低0.3（2.9标准差[2.8]对3.2[3.1]，P<0.01）。在双变量分析中，使用脓毒症医嘱集的患者医院死亡率低6.3%（9.7%对16.0%，P<0.01），从急诊科分诊到使用抗生素的中位时间少54分钟（125四分位间距[IQR，68 - 221]对179[98 - 379]，P<0.01），中位低血压总时长少时长少2.1小时（5.5 IQR[2.0 - 15.0]对7.6[2.5 - 21.8]，P<0.01），脓毒性休克的发生率低3.2%（22.0%对25.4%，P<0.01）。使用医嘱集与住院中位天数减少1.1天相关（4.9[2.8 - 9.0]对6.0[3.2 - 12.1]，P<0.01），出院回家的患者多6.6%（61.4%对54.8%，P<0.01）。在多变量模型中，使用脓毒症医嘱集与较低的医院死亡率独立相关（比值比0.70；95%置信区间，0.66 - 0.73）。
在一组脓毒症住院患者中，使用医嘱集与较低的医院死亡率独立相关。医嘱集可影响大规模质量改进工作。
