Scheer Christian S, Giamarellos-Bourboulis Evangelos J, Ferrer Ricard, Idelevich Evgeny A, Annane Djillali, Artigas Antonio, Aslan Abdullah Tarik, Bottari Gabriella, Bouma Hjalmar R, Černý Vladimir, Curić Radivojević Renata, Dakou Konstantina, Dewitte Ken, Elbahnasawy Mohamed, Gründling Matthias, Gurjar Mohan, Hästbacka Johanna, Kyprianou Miltiadis, Laribi Said, Lassen Annmarie, Lebedinskii Konstantin, Máca Jan, Malbrain Manu L N G, Monti Gianpaola, Ostermann Marlies, Osthoff Michael, Paiva José-Artur, Sabbatucci Michela, Śmiechowicz Jakub, Ştefan Mihai Gabriel, Vollmer Marcus, Vuković Natalija, Zaragkoulias Kyriakos, Reinhart Konrad, Linder Adam, Filipescu Daniela
Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, University Medicine Greifswald, Greifswald, Germany.
Fourth Department of Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece.
Am J Respir Crit Care Med. 2025 Apr;211(4):587-599. doi: 10.1164/rccm.202406-1167OC.
Early detection, standardized therapy, adequate infrastructure, and strategies for quality improvement should constitute essential components of every hospital's sepsis plan. To investigate the extent to which recommendations from the sepsis guidelines are implemented and the availability of infrastructure for the care of patients with sepsis in acute-care hospitals. A multidisciplinary cross-sectional questionnaire was used to investigate sepsis care in hospitals. This included the use of sepsis definitions, the implementation of sepsis guideline recommendations, diagnostic and therapeutic infrastructure, antibiotic stewardship, and quality improvement initiatives (QIIs) in hospitals. A total of 1,023 hospitals in 69 countries were included. Most of them, 835 (81.6%), were in Europe. Sepsis screening was used in 54.2% of emergency departments (EDs), 47.9% of wards, and 61.7% of ICUs. Sepsis management was standardized in 57.3% of EDs, 45.2% of wards, and 70.7% of ICUs. The implementation of comprehensive QIIs was associated with increased screening (EDs, +33.3%; wards, +44.4%; ICUs, +23.8% absolute difference) and increased standardized sepsis management (EDs, +33.6%; wards, +40.0%; ICUs, +17.7% absolute difference) compared with hospitals without QIIs. A total of 9.8% of hospitals had implemented ongoing QIIs, and 4.6% had invested in sepsis programs. The findings indicate that there is considerable room for improvement in a large number of mainly European hospitals, particularly with regard to early identification and standardized management of sepsis, the availability of guidelines, diagnostic and therapeutic infrastructure, and the implementation of QIIs. Further efforts are required to implement a more comprehensive and appropriate quality of care.
早期检测、标准化治疗、充足的基础设施以及质量改进策略应构成每家医院脓毒症计划的基本组成部分。为调查急性护理医院中脓毒症指南的建议实施程度以及脓毒症患者护理基础设施的可用性。采用多学科横断面问卷调查法对医院的脓毒症护理情况进行调查。这包括脓毒症定义的使用、脓毒症指南建议的实施、诊断和治疗基础设施、抗生素管理以及医院的质量改进措施（QIIs）。共纳入了69个国家的1023家医院。其中大多数，即835家（81.6%）在欧洲。54.2%的急诊科（EDs）、47.9%的病房和61.7%的重症监护病房（ICUs）使用了脓毒症筛查。57.3%的急诊科、45.2%的病房和70.7%的重症监护病房实现了脓毒症管理的标准化。与未实施QIIs的医院相比，全面实施QIIs与脓毒症筛查增加（急诊科，绝对差异+33.3%；病房，+44.4%；重症监护病房，+23.8%）以及脓毒症标准化管理增加（急诊科，+33.6%；病房，+40.0%；重症监护病房，+17.7%）相关。共有9.8%的医院实施了持续的QIIs，4.6%的医院对脓毒症项目进行了投资。研究结果表明，大量主要为欧洲的医院在脓毒症的早期识别和标准化管理、指南可用性、诊断和治疗基础设施以及QIIs的实施方面仍有很大的改进空间。需要进一步努力实施更全面、适当的护理质量。
