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评价社区医院脓毒症护理包依从性对患者预后的预测作用:一项回顾性研究。

Evaluating Sepsis Bundle Compliance as a Predictor for Patient Outcomes at a Community Hospital: A Retrospective Study.

机构信息

Author Affiliations: Inova Mount Vernon Hospital, Alexandria, Virginia (Mr Lawrence); George Mason University, Fairfax, Virginia (Drs Lee and Fadahunsi); and Inova Health System, Fairfax, Virginia (Dr Mowery).

出版信息

J Nurs Care Qual. 2024;39(3):252-258. doi: 10.1097/NCQ.0000000000000767. Epub 2024 Mar 11.

DOI:10.1097/NCQ.0000000000000767
PMID:38470467
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11116060/
Abstract

BACKGROUND

Clinicians are encouraged to use the Centers for Medicare & Medicaid Services early management bundle for severe sepsis and septic shock (SEP-1); however, it is unclear whether this process measure improves patient outcomes.

PURPOSE

The purpose of this study was to evaluate whether compliance with the SEP-1 bundle is a predictor of hospital mortality, length of stay (LOS), and intensive care unit LOS at a suburban community hospital.

METHODS

A retrospective observational study was conducted.

RESULTS

A total of 577 patients were included in the analysis. Compliance with the SEP-1 bundle was not a significant predictor for patient outcomes.

CONCLUSIONS

SEP-1 compliance may not equate with quality of health care. Efforts to comply with SEP-1 may help organizations develop systems and structures that improve patient outcomes. Health care leaders should evaluate strategies beyond SEP-1 compliance to ensure continuous improvement of outcomes for patients experiencing sepsis.

摘要

背景

鼓励临床医生使用医疗保险和医疗补助服务中心(Centers for Medicare & Medicaid Services)的严重脓毒症和脓毒性休克早期管理包(SEP-1);然而,目前尚不清楚该流程措施是否能改善患者的预后。

目的

本研究旨在评估在一家郊区社区医院,SEP-1 包的依从性是否是医院死亡率、住院时间(length of stay, LOS)和重症监护病房 LOS 的预测指标。

方法

进行了一项回顾性观察性研究。

结果

共有 577 名患者纳入分析。SEP-1 包的依从性不是患者预后的显著预测因素。

结论

SEP-1 的依从性可能并不等同于医疗保健质量。努力遵守 SEP-1 可能有助于组织建立系统和结构,从而改善患者的预后。医疗保健领导者应评估超越 SEP-1 依从性的策略,以确保接受脓毒症治疗的患者的预后不断得到改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/976b/11116060/7ab3410b1dda/nihms-1958767-f0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/976b/11116060/7ab3410b1dda/nihms-1958767-f0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/976b/11116060/7ab3410b1dda/nihms-1958767-f0001.jpg

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本文引用的文献

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The Centers for Disease Control and Prevention's Hospital Sepsis Program Core Elements.疾病控制与预防中心医院脓毒症项目核心要素
JAMA. 2023 Nov 7;330(17):1617-1618. doi: 10.1001/jama.2023.16693.
2
Compliance with SEP-1 guidelines is associated with improved outcomes for septic shock but not for severe sepsis.遵循SEP - 1指南与感染性休克患者预后改善相关,但与严重脓毒症患者的预后改善无关。
J Intensive Med. 2022 May 11;2(3):167-172. doi: 10.1016/j.jointm.2022.03.003. eCollection 2022 Jul.
3
The Importance of Shifting Sepsis Quality Measures From Processes to Outcomes.
将脓毒症质量指标从过程指标转变为结果指标的重要性。
JAMA. 2023 Feb 21;329(7):535-536. doi: 10.1001/jama.2023.0340.
4
Hospitals That Report Severe Sepsis and Septic Shock Bundle Compliance Have More Structured Sepsis Performance Improvement.报告严重脓毒症和脓毒性休克捆绑包依从性的医院在改善脓毒症方面的表现更具结构性。
J Patient Saf. 2022 Dec 1;18(8):e1231-e1236. doi: 10.1097/PTS.0000000000001062. Epub 2022 Jul 21.
5
SEP-1-Taking the Measure of a Measure.SEP-1-衡量一项衡量标准
JAMA Netw Open. 2021 Dec 1;4(12):e2138823. doi: 10.1001/jamanetworkopen.2021.38823.
6
Association Between Implementation of the Severe Sepsis and Septic Shock Early Management Bundle Performance Measure and Outcomes in Patients With Suspected Sepsis in US Hospitals.严重脓毒症和脓毒性休克早期管理捆绑包实施与美国医院疑似脓毒症患者结局的相关性研究。
JAMA Netw Open. 2021 Dec 1;4(12):e2138596. doi: 10.1001/jamanetworkopen.2021.38596.
7
Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021.拯救脓毒症运动:2021年脓毒症和脓毒性休克国际管理指南
Intensive Care Med. 2021 Nov;47(11):1181-1247. doi: 10.1007/s00134-021-06506-y. Epub 2021 Oct 2.
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