Shrestha Sachita, Kowalkowski Marc, Birken Sarah, Palakshappa Jessica, King Jessie, Miller Chadwick, Pogue Jason, Taylor Stephanie
Department of Internal Medicine, Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
J Hosp Med. 2025 Jul;20(7):800-807. doi: 10.1002/jhm.70052. Epub 2025 Apr 13.
Sepsis ranks among the "Big Three" conditions most prone to harmful diagnostic errors. Despite its high prevalence and severity, health systems lack effective and contextually tailored strategies to optimize diagnostic accuracy for sepsis.
The purpose of this study is to understand factors related to high sepsis diagnostic accuracy using principles and tools of safety and implementation science.
This is a multi-site study involving 20 hospitals across four states in the United States. The primary objectives are to (1) describe hospital-level variability and understand barriers and facilitators to sepsis diagnostic accuracy and (2) apply cross-case and coincidence analysis to determine minimally sufficient and necessary conditions for optimal sepsis diagnosis that minimizes under- and overtreatment. To identify barriers and facilitators of acute sepsis diagnosis, we will conduct electronic surveys and in-depth interviews with key informants from each hospital. We will use data from electronic health records (EHR) and data warehouses to operationalize sepsis diagnostic accuracy.
We have enrolled 20 hospitals and begum data collection. The findings of this study will be used to develop a context-specific toolkit that guides the selection of feasible and important strategies to promote optimal sepsis diagnosis in diverse hospitals settings.
The study uses tools and principles from safety and implementation science to generate first-of-its-kind evidence to improve diagnostic excellence in sepsis.
脓毒症位列最易出现有害诊断错误的“三大”病症之中。尽管其发病率高且病情严重，但卫生系统缺乏有效且因地制宜的策略来优化脓毒症的诊断准确性。
本研究旨在运用安全与实施科学的原理和工具，了解与脓毒症高诊断准确性相关的因素。
这是一项多中心研究，涉及美国四个州的20家医院。主要目标是：（1）描述医院层面的差异，了解脓毒症诊断准确性的障碍和促进因素；（2）应用跨案例和一致性分析，确定实现最佳脓毒症诊断的最低限度充分必要条件，以尽量减少治疗不足和过度治疗。为了确定急性脓毒症诊断的障碍和促进因素，我们将对每家医院的关键信息提供者进行电子调查和深入访谈。我们将使用电子健康记录（EHR）和数据仓库中的数据来衡量脓毒症诊断准确性。
我们已招募了20家医院并开始收集数据。本研究的结果将用于开发一个针对具体情况的工具包，以指导选择可行且重要的策略，在不同医院环境中促进最佳脓毒症诊断。
本研究运用安全与实施科学的工具和原理，生成同类首个证据，以提高脓毒症的诊断水平。
