Suliman Sally, Price John, Cahill Meredith, Young Taylor, Furmanek Stephen, Galvis Juan, Shoff Hugh, Parra Frankie, Stevenson Gina, Cavallazzi Rodrigo
Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Disorders, University of Louisville, Louisville, KY.
Department of Internal Medicine, Division of Infectious Diseases, University of Louisville, Louisville, KY.
Crit Care Explor. 2021 Jan 19;3(1):e0312. doi: 10.1097/CCE.0000000000000312. eCollection 2021 Jan.
Sepsis is associated with high morbidity and mortality and high healthcare costs. We hypothesized that a multifaceted quality improvement project would lead to an improvement in compliance with the sepsis "bundles."
Patients presenting to the emergency department that met criteria for sepsis at triage triggered notification of an emergency department physician and the sepsis response team in order to facilitate timely completion of the 3-hour bundles. The primary outcome was compliance with the seven sepsis bundle components. Secondary outcomes included all-cause inhospital mortality, hospital length of stay, and time in the emergency department.
The study was conducted at a 404-bed tertiary academic medical center over a 2-year period.
The study included patients that presented to the emergency department that met criteria for sepsis.
The study included 163 patients. Overall compliance with the sepsis bundle was 79% (95% CI, 72-84%). There was significant improvement in comparison with the hospital's historical compliance of 37% ( < 0.001). Compliance with the individual bundle components ranged from 80% to 100%. Sixteen patients died (10%) in the hospital. There was no statistically significant difference between the compliant and noncompliant groups regarding the secondary outcomes of length of stay or inhospital mortality.
This study found that implementation of a sepsis response team can improve compliance with completion of sepsis bundles. This indicates that it is feasible to implement a multidisciplinary quality initiative to improve timely treatment of patients with sepsis at an academic center using a resident-driven sepsis response team.
脓毒症与高发病率、高死亡率以及高昂的医疗费用相关。我们假设一个多方面的质量改进项目将提高对脓毒症“集束化治疗”的依从性。
在分诊时符合脓毒症标准的急诊科患者会触发通知急诊科医生和脓毒症应对小组，以促进3小时集束化治疗的及时完成。主要结局是对脓毒症集束化治疗七个组成部分的依从性。次要结局包括全因住院死亡率、住院时间和在急诊科的停留时间。
该研究在一家拥有404张床位的三级学术医疗中心进行，为期2年。
该研究纳入了在急诊科就诊且符合脓毒症标准的患者。
该研究纳入了163例患者。脓毒症集束化治疗的总体依从率为79%（95%可信区间，72 - 84%）。与该医院37%的历史依从率相比有显著提高（P < 0.001）。对各个集束化治疗组成部分的依从率在80%至100%之间。16例患者（10%）在医院死亡。在住院时间或住院死亡率这些次要结局方面，依从组和不依从组之间没有统计学上的显著差异。
本研究发现实施脓毒症应对小组可提高脓毒症集束化治疗完成情况的依从性。这表明在学术中心利用住院医师驱动的脓毒症应对小组实施多学科质量改进措施以改善脓毒症患者的及时治疗是可行的。
