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Gustad LT, Bangstad IL, Torsvik M, Rise MB. Nurses' and Physicians' Experiences After Implementation of a Quality Improvement Project to Improve Sepsis Awareness in Hospitals. J Multidiscip Healthc 2024; 17:29-41. [PMID: 38192738 PMCID: PMC10773249 DOI: 10.2147/jmdh.s439017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/27/2023] [Indexed: 01/10/2024] Open
Abstract
Purpose Previous research has explored nurses´ experience with the implementation of early detection alert systems, and nurses and physicians' perceptions of sepsis management and use of sepsis triage. As one of the first, this study aims to investigate the perceived usefulness of an interdisciplinary quality improvement project including standardized sepsis patient pathway to improve the early identification and treatment of sepsis patients. Participants and Methods This study was a qualitative study that employed semi-structured interviews with thirteen ward nurses and five ward physicians recruited by convenience and respondent-driven sampling, respectively. The interviews explored the perceived usefulness of mutual training in sepsis care in medical hospital wards. We applied Systematic Text Condensation to analyze the experiences and knowledge of professional identification and cooperation in early identification of sepsis patients. Results The results revealed three main themes: Awareness of sepsis, collaboration between nurses and physicians, and clinical assessment and judgement. The findings highlighted the positive impact of the project in terms of raising awareness, improving communication, and enhancing the ability to detect and treat sepsis. The study also identified the importance of repetition and reminders to maintain awareness, the need for ongoing training for new healthcare professionals, and the challenges of collaboration and decision-making processes. Conclusion The sepsis intervention seemed successful in improving awareness of sepsis and enhancing interprofessional collaboration between nurses and physicians. Health professionals continued to rely on their clinical judgment but increased the use of objective measurements and communication of vital signs. Continuous repetition and education for new colleagues were identified as important factors for the sustainability of the intervention. Overall, the study highlights the importance of standardized protocols and training for early detection and management of sepsis in healthcare settings.
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Affiliation(s)
- Lise Tuset Gustad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Nord-Trøndelag Hospital Trust, Department of Medicine, Levanger Hospital, Levanger, Norway
| | | | - Malvin Torsvik
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Marit By Rise
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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2
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Lan L, Zhou M, Chen X, Dai M, Wang L, Li H. Prognostic accuracy of SOFA, MEWS, and SIRS criteria in predicting the mortality rate of patients with sepsis: A meta-analysis. Nurs Crit Care 2023. [PMID: 38129945 DOI: 10.1111/nicc.13016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND In recent years, some studies classified patients with sepsis and predicted their mortality by using some evaluation scales. Several studies reported significant differences in the predictive values of several tools, and the non-uniformity of the cut-off value. OBJECTIVE To determine and compare the prognostic accuracy of Sequential Organ Failure Assessment (SOFA) score, Modified Early Warning Score (MEWS), and Systemic Inflammatory Response Syndrome (SIRS) criteria in predicting the mortality of patients with sepsis. METHODS This study comprised of systematic literature review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched PubMed, Embase, Web of Science and Cochrane Library databases from their establishment to July 31, 2022. The research articles published in the index journals provide sufficient data (true positive, false positive, true negative, and false negative results) for patients with sepsis. The combined sensitivity and specificity of the 95% confidence interval (CI) were calculated using the bivariate random effect model (BRM). The hierarchical overall subject working characteristics (HSROC) curve was drawn to evaluate the accuracy of the overall prognosis. RESULTS Data of 55 088 patients from 32 studies were included in this meta-analysis. SOFA had an intermediate sensitivity of 0.73 (95% CI: 0.67-0.78) and a specificity of 0.70 (0.63-0.76). SIRS criteria had the highest sensitivity of 0.75 (0.66-0.82) and the lowest specificity of 0.40 (0.29-0.52). MEWS had the lowest sensitivity of 0.49 (0.40-0.59) and the highest specificity of 0.82 (0.78-0.86). CONCLUSIONS Among SOFA, MEWS, and SIRS criteria, SOFA showed moderate sensitivity and specificity for predicting mortality in patients with sepsis, the highest sensitivity of SIRS and the strongest specificity of MEWS for predicting mortality in patients with sepsis. The future research direction is to combine the relevant indicators of MEWS and SIRS to develop a measurement tool with high reliability and validity. RELEVANCE TO CLINICAL PRACTICE The review provides useful insights into the prognostic accuracy of different assessment tools in predicting mortality in sepsis patients, which will help clinicians choose the most appropriate tool for early identification and treatment of sepsis. The findings may also contribute to the development of more accurate and reliable prognostic models for sepsis.
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Affiliation(s)
- Lin Lan
- Department of Emergency Medicine,West China Hospital, Sichuan University/West China School of Nursing,Sichuan University, Chengdu, China
- Institute of Disaster Medicine, Sichuan University, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Meichi Zhou
- Nephrology and Urology Ward, West China Hospital,Sichuan University/ West China School of Nursing, Sichuan University Chengdu, Chengdu, China
| | - Xiaoli Chen
- Department of Emergency Medicine,West China Hospital, Sichuan University/West China School of Nursing,Sichuan University, Chengdu, China
- Institute of Disaster Medicine, Sichuan University, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Min Dai
- Department of Emergency Medicine,West China Hospital, Sichuan University/West China School of Nursing,Sichuan University, Chengdu, China
- Institute of Disaster Medicine, Sichuan University, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Ling Wang
- Department of Emergency Medicine,West China Hospital, Sichuan University/West China School of Nursing,Sichuan University, Chengdu, China
- Institute of Disaster Medicine, Sichuan University, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Hong Li
- Department of Emergency Medicine,West China Hospital, Sichuan University/West China School of Nursing,Sichuan University, Chengdu, China
- Institute of Disaster Medicine, Sichuan University, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
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Skei NV, Nilsen TIL, Knoop ST, Prescott H, Lydersen S, Mohus RM, Brkic A, Liyanarachi KV, Solligård E, Damås JK, Gustad LT. Long-term temporal trends in incidence rate and case fatality of sepsis and COVID-19-related sepsis in Norwegian hospitals, 2008-2021: a nationwide registry study. BMJ Open 2023; 13:e071846. [PMID: 37532480 PMCID: PMC10401253 DOI: 10.1136/bmjopen-2023-071846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES To estimate temporal trends in incidence rate (IR) and case fatality during a 14-year period from 2008 to 2021, and to assess possible shifts in these trends during the COVID-19 pandemic. SETTING All Norwegian hospitals 2008-2021. PARTICIPANTS 317 705 patients ≥18 year with a sepsis International Classification of Diseases 10th revision code retrieved from The Norwegian Patient Registry. PRIMARY AND SECONDARY MEASURES Annual age-standardised IRs with 95% CIs. Poisson regression was used to estimate changes in IRs across time, and logistic regression was used to estimate ORs for in-hospital death. RESULTS Among 12 619 803 adult hospitalisations, a total of 317 705 (2.5%) hospitalisations in 222 832 (70.0%) unique patients met the sepsis criteria. The overall age-standardised IR of a first sepsis admission was 246/100 000 (95% CI 245 to 247), whereas the age-standardised IR of all sepsis admissions was 352/100 000 (95% CI 351 to 354). In the period 2009-2019, the annual IR for a first sepsis episode was stable (IR ratio (IRR) per year, 0.999; 95% CI 0.994 to 1.004), whereas for recurrent sepsis the IR increased (annual IRR, 1.048; 95% CI 1.037 to 1.059). During the COVID-19 pandemic, the IRR for a first sepsis was 0.877 (95% CI 0.829 to 0.927) in 2020 and 0.929 (95% CI 0.870 to 0.992) in 2021, and for all sepsis it was 0.870 (95% CI 0.810 to 0.935) in 2020 and 0.908 (95% CI 0.840 to 0.980) in 2021, compared with the previous 11-year period. Case fatality among first sepsis admissions declined in the period 2009-2019 (annual OR 0.954 (95% CI 0.950 to 0.958)), whereas case fatality increased during the COVID-19 pandemic in 2020 (OR 1.061 (95% CI 1.001 to 1.124) and in 2021 (OR 1.164 (95% CI 1.098 to 1.233)). CONCLUSION The overall IR of sepsis increased from 2009 to 2019, due to an increasing IR of recurrent sepsis, and indicates that sepsis awareness with updated guidelines and education must continue.
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Affiliation(s)
- Nina Vibeche Skei
- Department of Anesthesia and Intensive Care, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Institute of Circulation and Medical Imaging, Mid-Norway Centre of Sepsis Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tom Ivar Lund Nilsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Siri Tandberg Knoop
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Hallie Prescott
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, Michigan, USA
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Randi Marie Mohus
- Institute of Circulation and Medical Imaging, Mid-Norway Centre of Sepsis Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Anaesthesia and Intensive Care, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Alen Brkic
- Research Department, Sørlandet Sykehus HF, Kristiansand, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kristin Vardheim Liyanarachi
- Institute of Circulation and Medical Imaging, Mid-Norway Centre of Sepsis Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Infectious Diseases, St. Olav's University Hospital, Trondheim, Norway
| | - Erik Solligård
- Institute of Circulation and Medical Imaging, Mid-Norway Centre of Sepsis Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jan Kristian Damås
- Institute of Circulation and Medical Imaging, Mid-Norway Centre of Sepsis Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Infectious Diseases, St. Olav's University Hospital, Trondheim, Norway
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lise Tuset Gustad
- Institute of Circulation and Medical Imaging, Mid-Norway Centre of Sepsis Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Medicine and Rehabilitation, Nord-Trondelag Hospital Trust, Levanger, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
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Regina J, Le Pogam MA, Niemi T, Akrour R, Pepe S, Lehn I, Wasserfallen JB, Calandra T, Meylan S. Sepsis awareness and knowledge amongst nurses, physicians and paramedics of a tertiary care center in Switzerland: A survey-based cross-sectional study. PLoS One 2023; 18:e0285151. [PMID: 37379303 DOI: 10.1371/journal.pone.0285151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/06/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Sepsis is a leading cause of morbidity and mortality. Prompt recognition and management are critical to improve outcomes. METHODS We conducted a survey among nurses and physicians of all adult departments of the Lausanne University Hospital (LUH) and paramedics transporting patients to our hospital. Measured outcomes included professionals' demographics (age, profession, seniority, unit of activity), quantification of prior sepsis education, self-evaluation, and knowledge of sepsis epidemiology, definition, recognition, and management. Correlation between surveyed personnel and sepsis perceptions and knowledge were assessed with univariable and multivariable logistic regression models. RESULTS Between January and October 2020, we contacted 1'216 of the 4'417 professionals (27.5%) of the LUH, of whom 1'116 (91.8%) completed the survey, including 619 of 2'463 (25.1%) nurses, 348 of 1'664 (20.9%) physicians and 149 of 290 (51.4%) paramedics. While 98.5% of the participants were familiar with the word "sepsis" (97.4% of nurses, 100% of physicians and 99.3% of paramedics), only 13% of them (physicians: 28.4%, nurses: 5.9%, paramedics: 6.8%) correctly identified the Sepsis-3 consensus definition. Similarly, only 48% and 49.3% of the physicians and 10.1% an 11.9% of the nurses knew that SOFA was a sepsis defining score and that the qSOFA score was a predictor of increased mortality, respectively. Furthermore, 15.8% of the physicians and 1.0% of the nurses knew the three components of the qSOFA score. For patients with suspected sepsis, 96.1%, 91.6% and 75.8% of physicians respectively chose blood cultures, broad-spectrum antibiotics and fluid resuscitation as therapeutic interventions to be initiated within 1 (76.4%) to 3 (18.2%) hours. For nurses and physicians, recent training correlated with knowledge of SOFA score (ORs [95%CI]: 3.956 [2.018-7.752] and 2.617 [1.527-4.485]) and qSOFA (ORs [95%CI]: 5.804 [2.653-9.742] and 2.291 [1.342-3.910]) scores purposes. Furthermore, recent training also correlated with adequate sepsis definition (ORs [95%CI]: 1.839 [1.026-3.295]) and the components of qSOFA (ORs [95%CI]: 2.388 [1.110-5.136]) in physicians. CONCLUSIONS This sepsis survey conducted among physicians, nurses and paramedics of a tertiary Swiss medical center identified a deficit of sepsis awareness and knowledge reflecting a lack of sepsis-specific continuing education requiring immediate corrective measures.
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Affiliation(s)
- Jean Regina
- Department of Medicine, Infectious Diseases Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Marie-Annick Le Pogam
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Tapio Niemi
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Rachid Akrour
- Service of Geriatrics and Geriatric Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - Santino Pepe
- Medical Directorate, Lausanne University Hospital, Lausanne, Switzerland
| | - Isabelle Lehn
- Director of Nursing, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Thierry Calandra
- Department of Medicine, Infectious Diseases Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Department of Medicine and Department of Laboratory Medicine and Pathology, Service of Immunology and Allergy, Center for Human Immunology Lausanne, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
- Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, University of Paris Cité, Paris, France
| | - Sylvain Meylan
- Department of Medicine, Infectious Diseases Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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5
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Radhakrishnan NS, Lukose K, Cartwright R, Sleiman A, Matey N, Lim D, LeGault T, Pollard S, Gravina N, Southwick FS. Prospective application of the interdisciplinary bedside rounding checklist 'TEMP' is associated with reduced infections and length of hospital stay. BMJ Open Qual 2022; 11:bmjoq-2022-002045. [PMID: 36588303 PMCID: PMC9723909 DOI: 10.1136/bmjoq-2022-002045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/05/2022] [Indexed: 12/09/2022] Open
Abstract
Protocols that enhance communication between nurses, physicians and patients have had a variable impact on the quality and safety of patient care. We combined standardised nursing and physician interdisciplinary bedside rounds with a mnemonic checklist to assure all key nursing care components were modified daily. The mnemonic TEMP allowed the rapid review of 11 elements. T stands for tubes assuring proper management of intravenous lines and foleys; E stands for eating, exercise, excretion and sleep encouraging a review of orders for diet, exercise, laxatives to assure regular bowel movements, and inquiry about sleep; M stands for monitoring reminding the team to review the need for telemetry and the frequency of vital sign monitoring as well as the need for daily blood tests; and P stands for pain and plans reminding the team to discuss pain medications and to review the management plan for the day with the patient and family. Faithful implementation eliminated central line-associated bloodstream infections and catheter-associated urinary tract infections and resulted in a statistically significant reduction in average hospital length of stay of 13.3 hours, one unit achieving a 23-hour reduction. Trends towards reduced 30-day readmissions (20% down to 10%-11%) were observed. One unit improved the percentage of patients who reported nurses and doctors always worked together as a team from a 56% baseline to 75%. However, the combining of both units failed to demonstrate statistically significant improvement. Psychologists well versed in implementing behavioural change were recruiting to improve adherence to our protocols. Following training physicians and nurses achieved adherence levels of over 70%. A high correlation (r2=0.69) between adherence and reductions in length of stay was observed emphasising the importance of rigorous training and monitoring of performance to bring about meaningful and reliable improvements in the efficiency and quality of patient care.
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Affiliation(s)
- Nila S Radhakrishnan
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Lukose
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Richard Cartwright
- Office of Clinical Quality and Patient Safety, University of Florida Health, Gainesville, Florida, USA
| | - Andressa Sleiman
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Nicholas Matey
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Duke Lim
- Department of Nursing, University of Florida Health, Gainesville, Florida, USA
| | - Tiffany LeGault
- Department of Nursing, University of Florida Health, Gainesville, Florida, USA
| | - Sapheria Pollard
- Department of Nursing, University of Florida Health, Gainesville, Florida, USA
| | - Nicole Gravina
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Frederick S Southwick
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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6
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Bashiri FS, Caskey JR, Mayampurath A, Dussault N, Dumanian J, Bhavani SV, Carey KA, Gilbert ER, Winslow CJ, Shah NS, Edelson DP, Afshar M, Churpek MM. Identifying infected patients using semi-supervised and transfer learning. J Am Med Inform Assoc 2022; 29:1696-1704. [PMID: 35869954 PMCID: PMC9471712 DOI: 10.1093/jamia/ocac109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/13/2022] [Accepted: 07/01/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Early identification of infection improves outcomes, but developing models for early identification requires determining infection status with manual chart review, limiting sample size. Therefore, we aimed to compare semi-supervised and transfer learning algorithms with algorithms based solely on manual chart review for identifying infection in hospitalized patients.
Materials and Methods
This multicenter retrospective study of admissions to 6 hospitals included “gold-standard” labels of infection from manual chart review and “silver-standard” labels from nonchart-reviewed patients using the Sepsis-3 infection criteria based on antibiotic and culture orders. “Gold-standard” labeled admissions were randomly allocated to training (70%) and testing (30%) datasets. Using patient characteristics, vital signs, and laboratory data from the first 24 hours of admission, we derived deep learning and non-deep learning models using transfer learning and semi-supervised methods. Performance was compared in the gold-standard test set using discrimination and calibration metrics.
Results
The study comprised 432 965 admissions, of which 2724 underwent chart review. In the test set, deep learning and non-deep learning approaches had similar discrimination (area under the receiver operating characteristic curve of 0.82). Semi-supervised and transfer learning approaches did not improve discrimination over models fit using only silver- or gold-standard data. Transfer learning had the best calibration (unreliability index P value: .997, Brier score: 0.173), followed by self-learning gradient boosted machine (P value: .67, Brier score: 0.170).
Discussion
Deep learning and non-deep learning models performed similarly for identifying infection, as did models developed using Sepsis-3 and manual chart review labels.
Conclusion
In a multicenter study of almost 3000 chart-reviewed patients, semi-supervised and transfer learning models showed similar performance for model discrimination as baseline XGBoost, while transfer learning improved calibration.
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Affiliation(s)
- Fereshteh S Bashiri
- Department of Medicine, University of Wisconsin-Madison , Madison, Wisconsin, USA
| | - John R Caskey
- Department of Medicine, University of Wisconsin-Madison , Madison, Wisconsin, USA
| | - Anoop Mayampurath
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison , Madison, Wisconsin, USA
| | - Nicole Dussault
- Pritzker School of Medicine, University of Chicago , Chicago, Illinois, USA
| | - Jay Dumanian
- Pritzker School of Medicine, University of Chicago , Chicago, Illinois, USA
| | | | - Kyle A Carey
- Department of Medicine, University of Chicago , Chicago, Illinois, USA
| | - Emily R Gilbert
- Department of Medicine, Loyola University , Chicago, Illinois, USA
| | - Christopher J Winslow
- Department of Medicine, NorthShore University HealthSystem , Evanston, Illinois, USA
| | - Nirav S Shah
- Department of Medicine, University of Chicago , Chicago, Illinois, USA
- Department of Medicine, NorthShore University HealthSystem , Evanston, Illinois, USA
| | - Dana P Edelson
- Department of Medicine, University of Chicago , Chicago, Illinois, USA
| | - Majid Afshar
- Department of Medicine, University of Wisconsin-Madison , Madison, Wisconsin, USA
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison , Madison, Wisconsin, USA
| | - Matthew M Churpek
- Department of Medicine, University of Wisconsin-Madison , Madison, Wisconsin, USA
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison , Madison, Wisconsin, USA
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7
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Baker E. Improving sepsis recognition through use of the Sepsis Trust's community screening tool. Br J Community Nurs 2022; 27:69-75. [PMID: 35137616 DOI: 10.12968/bjcn.2022.27.2.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sepsis is associated with high levels of morbidity and mortality. All healthcare professionals have a responsibility to ensure they have sufficient knowledge to effectively screen patients for signs and symptoms of sepsis. In the community setting, screening for sepsis can be challenging, due to the complexity within the patient population and difficulties associated with observation for changes in the patient's condition. The Sepsis Trust community nursing sepsis screening tool provides decision-making support to community healthcare professionals, enabling them to make a rapid assessment for risk factors for sepsis, ensuring a proportionate, consistent and appropriate response. Through implementation of a decision-support tool within the clinical setting, it is likely that patients at risk of sepsis will be identified earlier, and patients will be escalated in a more consistent manner. This process of improving consistency in practice can improve patient outcomes, including mortality, morbidity and overall patient experience.
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Affiliation(s)
- Edward Baker
- Lecturer in Applied Technology for Clinical Care, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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8
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Hagedoorn NN, Zachariasse JM, Borensztajn D, Adriaansens E, von Both U, Carrol ED, Eleftheriou I, Emonts M, van der Flier M, de Groot R, Herberg JA, Kohlmaier B, Lim E, Maconochie I, Martinón-Torres F, Nijman RG, Pokorn M, Rivero-Calle I, Tsolia M, Zavadska D, Zenz W, Levin M, Vermont C, Moll HA. Shock Index in the early assessment of febrile children at the emergency department: a prospective multicentre study. Arch Dis Child 2022; 107:116-122. [PMID: 34158280 PMCID: PMC8784994 DOI: 10.1136/archdischild-2020-320992] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 06/06/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE (1) To derive reference values for the Shock Index (heart rate/systolic blood pressure) based on a large emergency department (ED) population of febrile children and (2) to determine the diagnostic value of the Shock Index for serious illness in febrile children. DESIGN/SETTING Observational study in 11 European EDs (2017-2018). PATIENTS Febrile children with measured blood pressure. MAIN OUTCOME MEASURES Serious bacterial infection (SBI), invasive bacterial infection (IBI), immediate life-saving interventions (ILSIs) and intensive care unit (ICU) admission. The association between high Shock Index (>95th centile) and each outcome was determined by logistic regression adjusted for age, sex, referral, comorbidity and temperature. Additionally, we calculated sensitivity, specificity and negative/positive likelihood ratios (LRs). RESULTS Of 5622 children, 461 (8.2%) had SBI, 46 (0.8%) had IBI, 203 (3.6%) were treated with ILSI and 69 (1.2%) were ICU admitted. High Shock Index was associated with SBI (adjusted OR (aOR) 1.6 (95% CI 1.3 to 1.9)), ILSI (aOR 2.5 (95% CI 2.0 to 2.9)), ICU admission (aOR 2.2 (95% CI 1.4 to 2.9)) but not with IBI (aOR: 1.5 (95% CI 0.6 to 2.4)). For the different outcomes, sensitivity for high Shock Index ranged from 0.10 to 0.15, specificity ranged from 0.95 to 0.95, negative LRs ranged from 0.90 to 0.95 and positive LRs ranged from 1.8 to 2.8. CONCLUSIONS High Shock Index is associated with serious illness in febrile children. However, its rule-out value is insufficient which suggests that the Shock Index is not valuable as a screening tool for all febrile children at the ED.
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Affiliation(s)
| | - Joany M Zachariasse
- General Paediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dorine Borensztajn
- Department of Pediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Elise Adriaansens
- General Paediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr von Haunersches Children's Hospital, Children's Clinic and Children's Polyclinic of the Ludwig Maximilian University of Munich, Munchen, Germany,Partner Site Munich, German Centre for Infection Research, Braunschweig, Germany
| | - Enitan D Carrol
- Institute of Infection, Veterinary and Ecological Sciences, Global Health Liverpool, University of Liverpool, Liverpool, UK,Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Irini Eleftheriou
- Second Department of Paediatrics, P and A Kyriakou Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marieke Emonts
- Paediatric Immunology, Infectious Diseases and Allergy, Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Michiel van der Flier
- Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands,Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud University, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Ronald de Groot
- Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands,Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud University, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Jethro Adam Herberg
- Division of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Benno Kohlmaier
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Emma Lim
- Paediatric Immunology, Infectious Diseases and Allergy, Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Federico Martinón-Torres
- Genetics, Vaccines, Infections and Paediatrics Research Group (GENVIP), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ruud Gerard Nijman
- Division of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Marko Pokorn
- Department of Infectious Diseases, Ljubljana University Clinical Center, Ljubljana, Slovenia
| | - Irene Rivero-Calle
- Genetics, Vaccines, Infections and Paediatrics Research Group (GENVIP), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria Tsolia
- Second Department of Paediatrics, P and A Kyriakou Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dace Zavadska
- Department of Pediatrics, Rigas Stradinas University, Riga, Latvia
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Michael Levin
- Division of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Clementien Vermont
- Department of Paediatric Infectious Diseases and Immunology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Henriette A Moll
- Department of Pediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
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Panknin HT, Schröder S. Pflegekräfte sollten verstärkt miteinbezogen werden. PROCARE : DAS FORBILDUNGSMAGAZIN FUR PFLEGEBERUFE 2022; 27:20-24. [PMID: 36274832 PMCID: PMC9579523 DOI: 10.1007/s00735-022-1602-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Hardy-Thorsten Panknin
- ist Fachjournalist Medizin - Schwerpunkt Klinische Infektiologie Berlin, Berlin, Deutschland
| | - Stefan Schröder
- Chefarzt Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie am Krankenhaus Düren, Nordrhein-Westfalen, Deutschland
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10
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Steiger C, Phan NV, Huang H, Sun H, Chu JN, Reker D, Gwynne D, Collins J, Tamang S, McManus R, Lopes A, Hayward A, Baron RM, Kim EY, Traverso G. Dynamic Monitoring of Systemic Biomarkers with Gastric Sensors. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2102861. [PMID: 34713599 PMCID: PMC8693042 DOI: 10.1002/advs.202102861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/07/2021] [Indexed: 06/13/2023]
Abstract
Continuous monitoring in the intensive care setting has transformed the capacity to rapidly respond with interventions for patients in extremis. Noninvasive monitoring has generally been limited to transdermal or intravascular systems coupled to transducers including oxygen saturation or pressure. Here it is hypothesized that gastric fluid (GF) and gases, accessible through nasogastric (NG) tubes, commonly found in intensive care settings, can provide continuous access to a broad range of biomarkers. A broad characterization of biomarkers in swine GF coupled to time-matched serum is conducted . The relationship and kinetics of GF-derived analyte level dynamics is established by correlating these to serum levels in an acute renal failure and an inducible stress model performed in swine. The ability to monitor ketone levels and an inhaled anaesthetic agent (isoflurane) in vivo is demonstrated with novel NG-compatible sensor systems in swine. Gastric access remains a main stay in the care of the critically ill patient, and here the potential is established to harness this establishes route for analyte evaluation for clinical management.
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Affiliation(s)
- Christoph Steiger
- Koch Institute for Integrative Cancer ResearchMassachusetts Institute of TechnologyCambridgeMA02139USA
- Division of GastroenterologyBrigham and Women's HospitalHarvard Medical SchoolBostonMA02115USA
| | - Nhi V. Phan
- Koch Institute for Integrative Cancer ResearchMassachusetts Institute of TechnologyCambridgeMA02139USA
| | - Hen‐Wei Huang
- Koch Institute for Integrative Cancer ResearchMassachusetts Institute of TechnologyCambridgeMA02139USA
- Division of GastroenterologyBrigham and Women's HospitalHarvard Medical SchoolBostonMA02115USA
| | - Haoying Sun
- Koch Institute for Integrative Cancer ResearchMassachusetts Institute of TechnologyCambridgeMA02139USA
| | - Jacqueline N. Chu
- Koch Institute for Integrative Cancer ResearchMassachusetts Institute of TechnologyCambridgeMA02139USA
- Division of GastroenterologyMassachusetts General HospitalHarvard Medical SchoolBostonMA02115USA
| | - Daniel Reker
- Koch Institute for Integrative Cancer ResearchMassachusetts Institute of TechnologyCambridgeMA02139USA
- Division of GastroenterologyBrigham and Women's HospitalHarvard Medical SchoolBostonMA02115USA
| | - Declan Gwynne
- Koch Institute for Integrative Cancer ResearchMassachusetts Institute of TechnologyCambridgeMA02139USA
- Division of GastroenterologyBrigham and Women's HospitalHarvard Medical SchoolBostonMA02115USA
| | - Joy Collins
- Koch Institute for Integrative Cancer ResearchMassachusetts Institute of TechnologyCambridgeMA02139USA
| | - Siddartha Tamang
- Koch Institute for Integrative Cancer ResearchMassachusetts Institute of TechnologyCambridgeMA02139USA
| | - Rebecca McManus
- Koch Institute for Integrative Cancer ResearchMassachusetts Institute of TechnologyCambridgeMA02139USA
| | - Aaron Lopes
- Koch Institute for Integrative Cancer ResearchMassachusetts Institute of TechnologyCambridgeMA02139USA
| | - Alison Hayward
- Koch Institute for Integrative Cancer ResearchMassachusetts Institute of TechnologyCambridgeMA02139USA
- Division of Comparative MedicineMassachusetts Institute of TechnologyCambridgeMA02139USA
| | - Rebecca M. Baron
- Division of Pulmonary and Critical Care MedicineDepartment of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMA02115USA
| | - Edy Y. Kim
- Division of Pulmonary and Critical Care MedicineDepartment of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMA02115USA
| | - Giovanni Traverso
- Koch Institute for Integrative Cancer ResearchMassachusetts Institute of TechnologyCambridgeMA02139USA
- Division of GastroenterologyBrigham and Women's HospitalHarvard Medical SchoolBostonMA02115USA
- Department of Mechanical EngineeringMassachusetts Institute of TechnologyCambridgeMA02139USA
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11
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Alberto L, Marshall AP, Walker RM, Pálizas F, Aitken LM. Sensitivity and specificity of a quick sequential [Sepsis-Related] organ failure assessment sepsis screening tool. Int J Clin Pract 2021; 75:e14874. [PMID: 34529874 DOI: 10.1111/ijcp.14874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 08/06/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022] Open
Abstract
AIM There is limited evidence on the diagnostic accuracy of a quick Sequential [Sepsis-Related] Organ Failure Assessment (qSOFA) sepsis screening (SS) tool in developing nation health settings. The aim of this study was to test the diagnostic accuracy of a qSOFA-based SS tool, and the predictive validity of the qSOFA score in hospital ward patients from Argentina. METHODS Prospective observational study. Patients (≥18 years, without sepsis) were recruited within 24-48 hours of admission to a 169-bed tertiary referral private hospital in Buenos Aires. The index test was the qSOFA-based SS tool, and the reference standard sepsis diagnosed at discharge blindly evaluated with reference to the Sepsis-3. RESULTS In 1151 patients (median age 69.9 [IQR, 29.0]); 47 (4.1%) had sepsis, 413 (35.9%) had infection and 691 (60.0%) other diagnoses at discharge. The qSOFA-based SS tool (index test) had moderate sensitivity (60%), good specificity (89%), a very low positive (19%) and very high negative (98%) predictive value for sepsis diagnosed at discharge according to the Sepsis-3 criteria (reference standard). For the same outcome, the qSOFA score in isolation had a reasonable predictive validity area under receiver operating characteristics curve 0.77 (95% CI 0.70-0.83) P < 0.001. CONCLUSION The qSOFA score could reasonably discriminate patients at risk of developing sepsis; qSOFA-based screening may be valuable where no screening criteria are in place.
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Affiliation(s)
- Laura Alberto
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Gold Coast University Hospital, Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Rachel M Walker
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Fernando Pálizas
- Intensive Care Units, Clínicas Bazterrica and Santa Isabel, Ciudad de Buenos Aires, Argentina
| | - Leanne M Aitken
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Health Sciences at City, University of London, London, UK
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12
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Öztürk Birge A, Karabag Aydin A, Köroğlu Çamdeviren E. Intensive care nurses' awareness of identification of early sepsis findings. J Clin Nurs 2021; 31:2886-2899. [PMID: 34729839 DOI: 10.1111/jocn.16116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 12/29/2022]
Abstract
AIM To determine intensive care nurses' awareness of identification of early sepsis findings. BACKGROUND The incidence of sepsis is increasing in intensive care units, and if not identified early, it increases morbidity, mortality and cost of care. Intervention within one hour after the diagnosis of sepsis increases survival. Nurses' ability to identify early findings of sepsis affects the time of diagnosis of sepsis. DESIGN The study used a cross-sectional design. METHODS The sample of the study consisted of 544 nurses working in adult intensive care units of hospitals in Turkey. The study data were collected online between 11 January-8 April 2021 using the snowball method. Data were statically analysed. All procedures of the study adhered to the STROBE guidelines. RESULTS The nurses who had been working for 11 years or more, had worked with a patient diagnosed with sepsis in the last month and used a measurement tool in the diagnosis thought that it was significantly easier to determine the early warning findings of sepsis. In the study, the majority of nurses correctly identified the early findings of sepsis, but the rates of the correct responses to the variables of lactate >2 mM, leucopenia and hypothermia were low. Female gender, having a graduate degree, unit type, total work experience, having received training on sepsis and working with a patient diagnosed with sepsis in the last month made a significant difference in determining the early warning findings of sepsis accurately. CONCLUSIONS Nurses had a good rate of identifying early sepsis findings. Yet, they could not distinguish between early sepsis and late sepsis findings. RELEVANCE TO CLINICAL PRACTICE The results of the study can support nursing practices in the diagnostic process by considering the factors affecting nurses' ability to distinguish early sepsis findings from late sepsis findings and to identify them correctly.
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13
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Dierkes AM, Aiken LH, Sloane DM, McHugh MD. Association of hospital nursing and postsurgical sepsis. PLoS One 2021; 16:e0258787. [PMID: 34662355 PMCID: PMC8523045 DOI: 10.1371/journal.pone.0258787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022] Open
Abstract
Despite concerted research and clinical efforts, sepsis remains a common, costly, and often fatal occurrence. Little evidence exists for the relationship between institutional nursing resources and the incidence and outcomes of sepsis after surgery. The objective of this study was to examine whether hospital nursing resource quality is associated with postsurgical sepsis incidence and survival. This cross-sectional, secondary data analysis used registered nurses' reports on hospital nursing resources-staffing, education, and work environment-and multivariate logistic regressions to model their association with risk-adjusted postsurgical sepsis and mortality in 568 hospitals across four states. Better work environment quality was associated with lower odds of sepsis. While the likelihood of death among septic patients was nearly seven times that of non-septic patients, better nursing resources were associated with reduced mortality for all patients. Whereas the preponderance of sepsis research has focused on clinical interventions to prevent and treat sepsis, this study describes organizational characteristics hospital administrators may modify through organizational change targeting nurse staffing, education, and work environments to improve patient outcomes.
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Affiliation(s)
- Andrew M. Dierkes
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Linda H. Aiken
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Douglas M. Sloane
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Matthew D. McHugh
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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14
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Coiner SE, Wingo NP. Addressing Gaps in Nurses' Knowledge of Sepsis: A Literature Review. J Contin Educ Nurs 2021; 52:43-46. [PMID: 33373007 DOI: 10.3928/00220124-20201215-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/15/2020] [Indexed: 11/20/2022]
Abstract
Sepsis is a dangerous and costly health care condition requiring prompt identification and emergency treatment. Bedside nurses have a crucial role in these early steps. Nurses should receive effective and timely education on identifying and treating sepsis in their patient populations. The purpose of this article is to review the literature and to identify how current sepsis education methods are addressing the gaps in nursing knowledge of sepsis. PubMed and CINAHL databases were used to search the literature. After inclusion and exclusion criteria were applied, nine articles were chosen for synthesis. Synthesis revealed three major themes: (a) assessing nurse sepsis knowledge, (b) using electronic learning methods for education, and (c) incorporating simulation into sepsis training. Gaps in the literature were also identified. [J Contin Educ Nurs. 2021;52(1):43-46.].
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15
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Abstract
BACKGROUND Nurses are in a prime position to identify sepsis early by screening patients for sepsis, a skill that should be embedded into their daily practice. However, compliance with the sepsis bundle remains low. AIMS To explore the effects of sepsis training on knowledge, skills and attitude among ward-based nurses. METHODS Registered nurses from 16 acute surgical and medical wards were invited to anonymously complete a questionnaire. FINDINGS Response rate was 39% (98/250). Nurses with sepsis training had better knowledge of the National Early Warning Score 2 for sepsis screening, and the systemic inflammatory response syndrome (SIRS) criteria, demonstrated a more positive attitude towards sepsis screening and management, were more confident in screening patients for sepsis and more likely to have screened a patient for sepsis. CONCLUSIONS Sepsis training improves nurses' attitudes, knowledge and confidence with regards to sepsis screening and management, resulting in adherence to evidence-based care, and should become mandatory for all clinical staff.
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Affiliation(s)
- Eirian Edwards
- Advanced Nurse Practitioner, Betsi Cadwaladr University Health Board, Bangor, Gwynedd
| | - Lorelei Jones
- Lecturer in Healthcare Sciences (Healthcare improvement), School of Health Sciences, Bangor University, Bangor, Gwynedd
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16
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Islam S, Akand AR, Nova TT, Lehmann C, Chisti MJ. Sensitivity Patterns of Bacterial Pathogens Isolated from Blood Cultures of Under-Five Children with Pneumonia and Clinical Sepsis. Life (Basel) 2021; 11:life11050450. [PMID: 34069789 PMCID: PMC8157259 DOI: 10.3390/life11050450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/12/2021] [Accepted: 05/15/2021] [Indexed: 01/09/2023] Open
Abstract
Treatment options for pneumonia and sepsis by antibiotics are limited due to the development of multidrug-resistant bacterial strains. This unmatched case-control study determined the antibiotic sensitivity against bacterial isolates obtained from septic and nonseptic children with pneumonia. Children of either sex aged 0–59 months with a history of cough or shortness of breath and radiologically confirmed pneumonia were enrolled in this study. Cases with clinical signs of sepsis at admission (n = 151) were compared to cases without sepsis as controls (n = 107). A total of 205 children had a performance of blood culture, with 123 children suffering from clinical sepsis. Blood cultures showed bacterial growth in 19% of the septic samples, with 8% coagulase-negative staphylococci and 2.4% Acinetobacter species. Only 1.6% of the cases were infected by Streptococcus pneumonia, Haemophilus influenzae, Salmonella typhi and Klebsiella. In contrast, children without sepsis presented positive blood cultures with growth of Salmonella typhi in 2.4% of the cases and growth of Klebsiella in 1.2%. Bacteria were sensitive to imipenem in 100% of the cases (86% for meropenem, 83% for ceftazidime and 76% for ciprofloxacin). The mortality rate was significantly higher in children with pneumonia complicated by sepsis (odds ratio (OR) = 3.02, 95% confidence interval (CI), 1.11–8.64, p < 0.027). Knowledge about specific laboratory characteristics in children with pneumonia will facilitate an early diagnosis and treatment of sepsis and reduce mortality.
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Affiliation(s)
- Sufia Islam
- Department of Pharmacy, East West University, Dhaka 1212, Bangladesh; (A.R.A.); (T.T.N.)
- Correspondence: ; Tel.: +880-9666775577 (ext. 385)
| | - Ashiqur Rahman Akand
- Department of Pharmacy, East West University, Dhaka 1212, Bangladesh; (A.R.A.); (T.T.N.)
| | - Tasnova Tasnim Nova
- Department of Pharmacy, East West University, Dhaka 1212, Bangladesh; (A.R.A.); (T.T.N.)
| | - Christian Lehmann
- Department of Anesthesia, Pain Management and Perioperative Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 1X5, Canada;
| | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh, Nutrition & Clinical Services Division, Dhaka 1212, Bangladesh;
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17
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Mar Minn M, Aung NM, Kyaw DZ, Zaw TT, Chann PN, Khine HE, McLoughlin S, Kelleher AD, Tun NL, Oo TZC, Myint NPST, Law M, Mar Kyi M, Hanson J. The comparative ability of commonly used disease severity scores to predict death or a requirement for ICU care in patients hospitalised with possible sepsis in Yangon, Myanmar. Int J Infect Dis 2021; 104:543-550. [PMID: 33493689 DOI: 10.1016/j.ijid.2021.01.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To determine the comparative prognostic utility of commonly used disease prediction scores in adults with presumed community-acquired sepsis in a resource-limited tropical setting. METHODS This prospective, observational study was performed on the medical ward of a tertiary-referral hospital in Yangon, Myanmar. The ability of the National Early Warning Score 2 (NEWS2), quick NEWS (qNEWS), quick Sequential Organ Failure Assessment (qSOFA) score, Universal Vital Assessment (UVA) and Sequential Organ Failure Assessment (SOFA) scores to predict a complicated inpatient course (death or requirement for intensive care unit (ICU) support) in patients with two or more systemic inflammatory response syndrome criteria was determined. RESULTS Among the 509 patients, 30 (6%) were HIV-seropositive. The most commonly confirmed diagnoses were tuberculosis (30/509, 5.9%) and measles (26/509, 5.1%). Overall, 75/509 (14.7%) died or required ICU support. All the scores except the qSOFA score, which was inferior, had a similar ability to predict a complicated inpatient course. CONCLUSIONS In this resource-limited tropical setting, disease severity scores calculated at presentation using only vital signs-such as the NEWS2 score-identified high-risk sepsis patient as well as the SOFA score, which is calculated at 24 h and which also requires laboratory data. Use of these simple clinical scores can be used to facilitate recognition of the high-risk patient and to optimise the use of finite resources.
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Affiliation(s)
- Mar Mar Minn
- Insein General Hospital, Insein Township, Yangon, Myanmar
| | - Ne Myo Aung
- Insein General Hospital, Insein Township, Yangon, Myanmar; University of Medicine 2, North Okkalapa Township, Yangon, Myanmar; Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar
| | - De Zin Kyaw
- Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar
| | - Thet Tun Zaw
- Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar
| | - Pyae Nyein Chann
- Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar
| | - Hnin Ei Khine
- Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar
| | | | | | - Ne Lin Tun
- Insein General Hospital, Insein Township, Yangon, Myanmar; University of Medicine 2, North Okkalapa Township, Yangon, Myanmar; Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar
| | - Thin Zar Cho Oo
- Insein General Hospital, Insein Township, Yangon, Myanmar; University of Medicine 2, North Okkalapa Township, Yangon, Myanmar; Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar
| | - Nan Phyu Sin Toe Myint
- Insein General Hospital, Insein Township, Yangon, Myanmar; University of Medicine 2, North Okkalapa Township, Yangon, Myanmar; Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar
| | - Matthew Law
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mar Mar Kyi
- Insein General Hospital, Insein Township, Yangon, Myanmar; University of Medicine 2, North Okkalapa Township, Yangon, Myanmar; Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar
| | - Josh Hanson
- University of Medicine 2, North Okkalapa Township, Yangon, Myanmar; Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar; The Kirby Institute, University of New South Wales, Sydney, Australia.
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18
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Rogne T, Solligård E, Burgess S, Brumpton BM, Paulsen J, Prescott HC, Mohus RM, Gustad LT, Mehl A, Åsvold BO, DeWan AT, Damås JK. Body mass index and risk of dying from a bloodstream infection: A Mendelian randomization study. PLoS Med 2020; 17:e1003413. [PMID: 33196656 PMCID: PMC7668585 DOI: 10.1371/journal.pmed.1003413] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 10/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In observational studies of the general population, higher body mass index (BMI) has been associated with increased incidence of and mortality from bloodstream infection (BSI) and sepsis. On the other hand, higher BMI has been observed to be apparently protective among patients with infection and sepsis. We aimed to evaluate the causal association of BMI with risk of and mortality from BSI. METHODS AND FINDINGS We used a population-based cohort in Norway followed from 1995 to 2017 (the Trøndelag Health Study [HUNT]), and carried out linear and nonlinear Mendelian randomization analyses. Among 55,908 participants, the mean age at enrollment was 48.3 years, 26,324 (47.1%) were men, and mean BMI was 26.3 kg/m2. During a median 21 years of follow-up, 2,547 (4.6%) participants experienced a BSI, and 451 (0.8%) died from BSI. Compared with a genetically predicted BMI of 25 kg/m2, a genetically predicted BMI of 30 kg/m2 was associated with a hazard ratio for BSI incidence of 1.78 (95% CI: 1.40 to 2.27; p < 0.001) and for BSI mortality of 2.56 (95% CI: 1.31 to 4.99; p = 0.006) in the general population, and a hazard ratio for BSI mortality of 2.34 (95% CI: 1.11 to 4.94; p = 0.025) in an inverse-probability-weighted analysis of patients with BSI. Limitations of this study include a risk of pleiotropic effects that may affect causal inference, and that only participants of European ancestry were considered. CONCLUSIONS Supportive of a causal relationship, genetically predicted BMI was positively associated with BSI incidence and mortality in this cohort. Our findings contradict the "obesity paradox," where previous traditional epidemiological studies have found increased BMI to be apparently protective in terms of mortality for patients with BSI or sepsis.
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Affiliation(s)
- Tormod Rogne
- Gemini Center for Sepsis Research, Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, United States of America
- Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Erik Solligård
- Gemini Center for Sepsis Research, Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stephen Burgess
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Ben M. Brumpton
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Julie Paulsen
- Department of Medical Genetics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hallie C. Prescott
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- VA Center for Clinical Management Research, Ann Arbor, Michigan, United States of America
| | - Randi M. Mohus
- Gemini Center for Sepsis Research, Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lise T. Gustad
- Gemini Center for Sepsis Research, Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Arne Mehl
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Bjørn O. Åsvold
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Andrew T. DeWan
- Gemini Center for Sepsis Research, Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, United States of America
| | - Jan K. Damås
- Gemini Center for Sepsis Research, Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Centre of Molecular Inflammation Research, Department of Clinical and Molecular Medicine, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Infectious Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Winter A, Jones WS, Allen AJ, Price DA, Rostron A, Filieri R, Graziadio S. The Clinical Need for New Diagnostics in the Identification and Management of Patients with Suspected Sepsis in UK NHS Hospitals: A Survey of Healthcare Professionals. Antibiotics (Basel) 2020; 9:antibiotics9110737. [PMID: 33114715 PMCID: PMC7693654 DOI: 10.3390/antibiotics9110737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022] Open
Abstract
Development of a new diagnostic is ideally driven by an understanding of the clinical need that the test addresses and the optimal role the test will have within a care pathway. This survey aimed to understand the clinical need for new sepsis diagnostics and to identify specific clinical scenarios that could be improved by testing. An electronic, cross-sectional survey was circulated to UK National Health Service (NHS) doctors and nurses who care for patients with suspected sepsis in hospitals. Two hundred and sixty-five participants completed the survey, representing 64 NHS Trusts in England. Sixty-seven percent of respondents suggested that the major cause of delay was during the initial identification of sepsis and the subsequent recognition of patients who were deteriorating. Existing blood tests did not enhance the confidence of consultants making their diagnoses. Those surveyed identified a role for a near-patient test to "rule out" suspected sepsis and, thereby, stop or postpone use of antibiotics. Current diagnostic tests are slow, non-specific, and do not reliably identify patients with a high suspicion of sepsis. As a result, they have a limited use in patient management and antibiotic stewardship. Future development of sepsis diagnostics should focus on overcoming these limitations.
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Affiliation(s)
- Amanda Winter
- NIHR Newcastle In Vitro Diagnostics Co-Operative, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; (A.J.A.); (S.G.)
- The Newcastle Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne NE1 4LP, UK;
- Correspondence:
| | - William Stephen Jones
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK; (W.S.J.); (A.R.)
| | - A. Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-Operative, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; (A.J.A.); (S.G.)
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK; (W.S.J.); (A.R.)
| | - D. Ashley Price
- The Newcastle Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne NE1 4LP, UK;
| | - Anthony Rostron
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK; (W.S.J.); (A.R.)
- Integrated Critical Care Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Kayll Road, Sunderland SR4 7TP, UK
| | - Raffaele Filieri
- Audencia Business School, Marketing Department, 8 Route de la Jonelière, B.P. 31222, 44312 Nantes, CEDEX 3, France;
| | - Sara Graziadio
- NIHR Newcastle In Vitro Diagnostics Co-Operative, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; (A.J.A.); (S.G.)
- The Newcastle Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne NE1 4LP, UK;
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Souza ALTD, Batalhão ME, Cárnio EC. Study of thermo-regulation as a worsening marker of experimental sepsis in an animal model. Rev Lat Am Enfermagem 2020; 28:e3290. [PMID: 32901764 PMCID: PMC7478883 DOI: 10.1590/1518-8345.3364.3290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 03/12/2020] [Indexed: 11/21/2022] Open
Abstract
Objective: to analyze variations in body temperature and in plasma nitrate and lactate concentrations in rats submitted to the experimental sepsis model. Method: a total of 40 rats divided equally into five groups. The induction of endotoxemia was performed with intravenous administration of lipopolysaccharide, 0.5 mg/Kg, 1.5 mg/Kg, 3.0 mg/Kg, and 10 mg/Kg, respectively. The control group received 0.5 mL of saline solution. The experiment lasted six hours, with evaluations performed at 0 (baseline data), 2nd, 4th, and 6thhours. Results: The animals that received doses up to 3.0 mg/kg showed a significant increase in body temperature compared to the group with 10 mg/kg, which showed a decrease in these values. The increase in plasma nitrate and lactate concentrations in the groups with lipopolysaccharide was significantly higher than in the group that received the saline solution and was correlated with the increase in body temperature. Conclusion: the variations in body temperature observed in this study showed the dose-dependent effect of lipopolysaccharide and were correlated with the increase in the concentrations of nitrate and plasma lactate biomarkers. The implications of this study are the importance of monitoring body temperature, together with the assessment of these pathophysiological markers, which suggest worsening in the prognosis of sepsis.
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Affiliation(s)
- André Luiz Thomaz de Souza
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil.,Faculdades Integradas do Vale do Ribeira, Faculdade de Enfermagem, Registro, SP, Brazil
| | - Marcelo Eduardo Batalhão
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Evelin Capellari Cárnio
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil
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21
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Branco MJC, Lucas APM, Marques RMD, Sousa PP. The role of the nurse in caring for the critical patient with sepsis. Rev Bras Enferm 2020; 73:e20190031. [PMID: 32578735 DOI: 10.1590/0034-7167-2019-0031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/13/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to know the nursing interventions in the identification, prevention and control of sepsis in critical patients. METHODS integrative review of the literature, with two parallel researches using different MesH terms, using the EBSCO database and Google Scholar. Nine studies were included in the sample. RESULTS nursing interventions are centered on the creation/implementation of protocols for the early recognition of sepsis, the training of teams to ensure a safe and effective approach and the adoption of measures for infection prevention and control as a way to prevent sepsis. FINAL CONSIDERATIONS the evidence shows that nurses are fundamental in the early identification, control and prevention of sepsis, preventing disease progression and contributing to decreased morbidity and mortality.
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Baghdadi JD, Wong MD, Uslan DZ, Bell D, Cunningham WE, Needleman J, Kerbel R, Brook R. Adherence to the SEP-1 Sepsis Bundle in Hospital-Onset v. Community-Onset Sepsis: a Multicenter Retrospective Cohort Study. J Gen Intern Med 2020; 35:1153-1160. [PMID: 32040837 PMCID: PMC7174506 DOI: 10.1007/s11606-020-05653-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/26/2019] [Accepted: 12/10/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sepsis is the leading cause of in-hospital death. The SEP-1 sepsis bundle is a protocol for early sepsis care that requires providers to diagnose and treat sepsis quickly. Limited evidence suggests that adherence to the sepsis bundle is lower in cases of hospital-onset sepsis. OBJECTIVE To compare sepsis bundle adherence in hospital-onset vs. community-onset sepsis. DESIGN Retrospective cohort study using multivariable analysis of clinical data. PARTICIPANTS A total of 4658 inpatients age 18 or older were identified by diagnosis codes consistent with sepsis or disseminated infection. SETTING Four university hospitals in California between 2014 and 2016. MAIN OUTCOMES AND MEASURES The primary outcome was adherence to key components of the sepsis bundle defined by the Centers for Medicare and Medicaid Services in their core measure, SEP-1. Covariates included clinical characteristics related to the patient, infection, and pathogen. KEY RESULTS Compared with community-onset, cases of hospital-onset sepsis were less likely to receive SEP-1 adherent care (relative risk 0.33, 95% confidence interval 0.29-0.38, p < 0.001). With the exception of vasopressors (RR 1.11, p = 0.002), each component of SEP-1 evaluated-blood cultures (RR 0.76, p < 0.001), serum lactate (RR 0.51, p < 0001), broad-spectrum antibiotics (RR 0.62, p < 0.001), intravenous fluids (0.47, p < 0.001), and follow-up lactate (RR 0.71, p < 0.001)-was less likely to be performed within the recommended time frame in hospital-onset sepsis. Within the hospital, cases of hospital-onset sepsis arising on the ward were less likely to receive SEP-1-adherent care than were cases arising in the intensive care unit (RR 0.68, p = 0.004). CONCLUSIONS Inpatients with hospital-onset sepsis receive different management than individuals with community-onset sepsis. It remains to be determined whether system-level factors, provider-level factors, or factors related to measurement explain the observed variation in care or whether variation in care affects outcomes.
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Affiliation(s)
- Jonathan D Baghdadi
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Mitchell D Wong
- UCLA Division of General Internal Medicine, Los Angeles, CA, USA
| | - Daniel Z Uslan
- UCLA Division of Infectious Diseases, Los Angeles, CA, USA
| | - Douglas Bell
- UCLA Division of General Internal Medicine, Los Angeles, CA, USA
| | - William E Cunningham
- UCLA Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, CA, USA
| | - Jack Needleman
- UCLA Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, CA, USA
| | | | - Robert Brook
- UCLA Department of Medicine, Los Angeles, CA, USA
- RAND Corporation, Santa Monica, CA, USA
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
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Impact of a Multidisciplinary Sepsis Initiative on Knowledge and Behavior in a Pediatric Center. Pediatr Qual Saf 2020; 5:e267. [PMID: 32426633 PMCID: PMC7190264 DOI: 10.1097/pq9.0000000000000267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 02/04/2020] [Indexed: 01/20/2023] Open
Abstract
Supplemental Digital Content is available in the text. Objective: Our institution performed an educational initiative targeting previously identified barriers to pediatric sepsis recognition and treatment. We hypothesized that provider knowledge, attitude, and behavior would be improved 1 year after implementation. Methods: This was a prospective, observational study of a multi-faceted quality initiative introduced to providers in the Emergency Department, inpatient wards, and Pediatric Intensive Care Unit of a tertiary care children’s hospital. Educational platforms consisted of quarterly electronic sepsis “newsletters,” brightly colored posters highlighting protocol and screening strategies displayed throughout the hospital, and low-fidelity simulation sessions (drills) led by trained staff and incorporated into daily workflows. The content was driven by feedback from a baseline needs assessment of sepsis education. One year after implementation, the needs assessment was repeated. Results: Over 3 months, facilitators conducted 197 drills and captured a majority of nurses (89%), pediatrics residents (96%), and respiratory therapists (62%). By 6 months, 241 sessions had been completed. Approximately 55.4% of the 442 eligible staff participated in our post-intervention survey. Overall, knowledge of diagnostic criteria for pediatric sepsis and septic shock increased from pre-intervention levels (P = 0.015). Among post-implementation respondents, drill participants outperformed their colleagues (P = 0.001). A greater percentage of post-intervention respondents indicated comfort with sepsis recognition (P < 0.001), and fewer reported hesitating to bring sepsis concerns to their care team (P < 0.01). Conclusions: Our findings suggest that a multidisciplinary curriculum balancing active education—through brief, targeted simulation—and general awareness—through electronic resources and a poster campaign—can improve sepsis-related knowledge, attitude, and behavior among pediatric practitioners.
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Husabø G, Nilsen RM, Flaatten H, Solligård E, Frich JC, Bondevik GT, Braut GS, Walshe K, Harthug S, Hovlid E. Early diagnosis of sepsis in emergency departments, time to treatment, and association with mortality: An observational study. PLoS One 2020; 15:e0227652. [PMID: 31968009 PMCID: PMC6975530 DOI: 10.1371/journal.pone.0227652] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/22/2019] [Indexed: 12/29/2022] Open
Abstract
Background Early recognition of sepsis is critical for timely initiation of treatment. The first objective of this study was to assess the timeliness of diagnostic procedures for recognizing sepsis in emergency departments. We define diagnostic procedures as tests used to help diagnose the condition of patients. The second objective was to estimate associations between diagnostic procedures and time to antibiotic treatment, and to estimate associations between time to antibiotic treatment and mortality. Methods This observational study from 24 emergency departments in Norway included 1559 patients with infection and at least two systemic inflammatory response syndrome criteria. We estimated associations using linear and logistic regression analyses. Results Of the study patients, 72.9% (CI 70.7–75.1) had documented triage within 15 minutes of presentation to the emergency departments, 44.9% (42.4–47.4) were examined by a physician in accordance with the triage priority, 44.4% (41.4–46.9) were adequately observed through continual monitoring of signs while in the emergency department, and 25.4% (23.2–27.7) received antibiotics within 1 hour. Delay or non-completion of these key diagnostic procedures predicted a delay of more than 2.5 hours to antibiotic treatment. Patients who received antibiotics within 1 hour had an observed 30-day all-cause mortality of 13.6% (10.1–17.1), in the timespan 2 to 3 hours after admission 5.9% (2.8–9.1), and 4 hours or later after admission 10.5% (5.7–15.3). Conclusions Key procedures for recognizing sepsis were delayed or not completed in a substantial proportion of patients admitted to the emergency department with sepsis. Delay or non-completion of key diagnostic procedures was associated with prolonged time to treatment with antibiotics. This suggests a need for systematic improvement in the initial management of patients admitted to emergency departments with sepsis.
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Affiliation(s)
- Gunnar Husabø
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- * E-mail:
| | - Roy M. Nilsen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Erik Solligård
- Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging and Mid-Norway Sepsis Research Group, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jan C. Frich
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Gunnar T. Bondevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Geir S. Braut
- Stavanger University Hospital, Stavanger, Norway
- Norwegian Board of Health Supervision, Oslo, Norway
| | - Kieran Walshe
- Alliance Manchester Business School, University of Manchester, Manchester, England, United Kingdom
| | - Stig Harthug
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Einar Hovlid
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Board of Health Supervision, Oslo, Norway
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Early Experience with a Novel Strategy for Assessment of Sepsis Risk: The Shock Huddle. Pediatr Qual Saf 2019; 4:e197. [PMID: 31572898 PMCID: PMC6708645 DOI: 10.1097/pq9.0000000000000197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 06/19/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction Severe sepsis/septic shock (SS), a leading cause of death in children, is a complex clinical syndrome that can be challenging to diagnose. To assist with the early and accurate diagnosis of this illness, we instituted an electronic scoring tool and developed a novel strategy for the assessment of currently hospitalized children at risk for SS. Methods The Shock Tool was created to alert providers to children at risk for SS. Above a threshold score of 45, patients were evaluated by a team from the pediatric intensive care unit (PICU), led by the Shock Nurse (RN), a specially trained PICU nurse, to assess their need for further therapies. Data related to this evaluation, termed a Shock Huddle, were collected and reviewed with the intensivist fellow on service. Results Over 1 year, 9,241 hospitalized patients were screened using the Shock Score. There were 206 Shock Huddles on 109 unique patients. Nearly 40% of Shock Huddles included a diagnostic or therapeutic intervention at the time of patient assessment, with the most frequent intervention being a fluid bolus. Shock Huddles resulted in a patient transfer to the PICU 10% of the time. Conclusion Implementation of an electronic medical record-based sepsis recognition tool paired with a novel strategy for rapid assessment of at-risk patients by a Shock RN is feasible and offers an alternative strategy to a traditional medical emergency team for the delivery of sepsis-related care. Further study is needed to describe the impact of this process on patient outcomes.
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Cahill M, Gleason K, Harkless G, Stanley J, Graber M. The Regulatory Implications of Engaging Registered Nurses in Diagnoses. JOURNAL OF NURSING REGULATION 2019. [DOI: 10.1016/s2155-8256(19)30110-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Alves B, Jouffroy R. [Training student nurses in taking blood cultures]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2019; 64:12-17. [PMID: 31345301 DOI: 10.1016/j.soin.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In cases of septic shock, high quality blood cultures are essential for identifying the causative agent and adapting the antibiotic treatment. Student nurses are relatively unfamiliar with recent guidelines on collecting blood cultures. Improving how they are taught during initial training, a key moment for the learning of best care practices, should help to optimise the global management of septic shock.
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Affiliation(s)
- Barbara Alves
- Service d'anesthésie réanimation, Samu de Paris, Hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Romain Jouffroy
- Service d'anesthésie réanimation, Samu de Paris, Hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
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Constantinescu C, Bodolea C, Pasca S, Teodorescu P, Dima D, Rus I, Tat T, Achimas-Cadariu P, Tanase A, Tomuleasa C, Einsele H. Clinical Approach to the Patient in Critical State Following Immunotherapy and/or Stem Cell Transplantation: Guideline for the On-Call Physician. J Clin Med 2019; 8:E884. [PMID: 31226876 PMCID: PMC6616972 DOI: 10.3390/jcm8060884] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022] Open
Abstract
: The initial management of the hematology patient in a critical state is crucial and poses a great challenge both for the hematologist and the intensive care unit (ICU) physician. After years of clinical practice, there is still a delay in the proper recognition and treatment of critical situations, which leads to late admission to the ICU. There is a much-needed systematic ABC (Airway, Breathing, Circulation) approach for the patients being treated on the wards as well as in the high dependency units because the underlying hematological disorder, as well as disease-related complications, have an increasing frequency. Focusing on score-based decision-making on the wards (Modified Early Warning Score (MEWS), together with Quick Sofa score), active sepsis screening with inflammation markers (C-reactive protein, procalcitonin, and presepsin), and assessment of microcirculation, organ perfusion, and oxygen supply by using paraclinical parameters from the ICU setting (lactate, central venous oxygen saturation (ScVO2), and venous-to-arterial carbon dioxide difference), hematologists can manage the immediate critical patient and improve the overall outcome.
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Affiliation(s)
- Catalin Constantinescu
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj Napoca, Romania.
- Intensive Care Unit, Ion Chiricuta Clinical Cancer Center, 400005 Cluj Napoca, Romania.
| | - Constantin Bodolea
- Department of Anesthesia, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj Napoca, Romania.
| | - Sergiu Pasca
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj Napoca, Romania.
| | - Patric Teodorescu
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj Napoca, Romania.
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400005 Cluj Napoca, Romania.
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400005 Cluj Napoca, Romania.
| | - Ioana Rus
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400005 Cluj Napoca, Romania.
| | - Tiberiu Tat
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400005 Cluj Napoca, Romania.
| | - Patriciu Achimas-Cadariu
- Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj Napoca, Romania.
| | - Alina Tanase
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania.
| | - Ciprian Tomuleasa
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj Napoca, Romania.
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400005 Cluj Napoca, Romania.
- Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Victor Babes Street, 400124 Cluj Napoca, Romania.
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Wuerzburg, 97070 Wuerzburg, Germany.
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Sathaporn N, Khwannimit B. Validation the performance of New York Sepsis Severity Score compared with Sepsis Severity Score in predicting hospital mortality among sepsis patients. J Crit Care 2019; 53:155-161. [PMID: 31247514 DOI: 10.1016/j.jcrc.2019.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to compare the performance of the New York Sepsis Severity Score (NYSSS) with the Sepsis Severity Score (SSS) and Acute Physiology and Chronic Health Evaluation and Simplified Acute Physiology Scores for predicting mortality in sepsis patients. METHOD A retrospective analysis was conducted in the intensive care unit. The primary outcome was in-hospital mortality. RESULTS Overall 1680 sepsis patients were enrolled. The hospital mortality rate was 44.4%. The NYSSS underestimated actual mortality with standard mortality ratio (SMR) of 1.28 (95%CI 1.19-1.38). However, the SSS slightly overestimated the actual mortality with an SMR of 0.94 (0.88-1.01). The NYSSS had moderate discrimination with an AUC of 0.772 (0.750-0.794), in contrast to the SSS which had good discrimination with an AUC of 0.889 (0.873-0.904). The AUC of the SSS was statistically higher than that of the NYSSS. The AUCs of both the NYSSS and SSS were significantly lower than other standard severity scores. The calibrations for all severity scores were poor. The SSS had better overall performance than the NYSSS (Brier score 0.149 and 0.201, respectively). CONCLUSION The SSS had better discrimination and overall performance than the NYSSS. However, both sepsis severity scores were poorly calibrated.
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Affiliation(s)
- Natthaka Sathaporn
- Division of Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Bodin Khwannimit
- Division of Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
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A Cost-Benefit Analysis of Automated Physiological Data Acquisition Systems Using Data-Driven Modeling. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2018; 3:245-263. [DOI: 10.1007/s41666-018-0040-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 10/27/2022]
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Wong DC, Knight J, Birks J, Tarassenko L, Watkinson PJ. Impact of Electronic Versus Paper Vital Sign Observations on Length of Stay in Trauma Patients: Stepped-Wedge, Cluster Randomized Controlled Trial. JMIR Med Inform 2018; 6:e10221. [PMID: 30381284 PMCID: PMC6236204 DOI: 10.2196/10221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/10/2018] [Accepted: 08/10/2018] [Indexed: 11/22/2022] Open
Abstract
Background Electronic recording of vital sign observations (e-Obs) has become increasingly prevalent in hospital care. The evidence of clinical impact for these systems is mixed. Objective The objective of our study was to assess the effect of e-Obs versus paper documentation (paper) on length of stay (time between trauma unit admission and “fit to discharge”) for trauma patients. Methods A single-center, randomized stepped-wedge study of e-Obs against paper was conducted in two 26-bed trauma wards at a medium-sized UK teaching hospital. Randomization of the phased intervention order to 12 study areas was computer generated. The primary outcome was length of stay. Results A total of 1232 patient episodes were randomized (paper: 628, e-Obs: 604). There were 37 deaths in hospital: 21 in the paper arm and 16 in the e-Obs arm. For discharged patients, the median length of stay was 5.4 (range: 0.2-79.0) days on the paper arm and 5.6 (range: 0.1-236.7) days on the e-Obs arm. Competing risks regression analysis for time to discharge showed no difference between the treatment arms (subhazard ratio: 1.05; 95% CI 0.82-1.35; P=.68). A greater proportion of patient episodes contained an Early Warning Score (EWS) ≥3 using the e-Obs system than using paper (subhazard ratio: 1.63; 95% CI 1.28-2.09; P<.001). However, there was no difference in the time to the subsequent observation, “escalation time” (hazard ratio 1.05; 95% CI 0.80-1.38; P=.70). Conclusions The phased introduction of an e-Obs documentation system was not associated with a change in length of stay. A greater proportion of patient episodes contained an EWS≥3 using the e-Obs system, but this was not associated with a change in “escalation time.” Trial Registration ISRCTN Registry ISRCTN91040762; http://www.isrctn.com/ISRCTN91040762 (Archived by WebCite at http://www.webcitation.org/72prakGTU)
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Affiliation(s)
- David Cw Wong
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Julia Knight
- Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jacqueline Birks
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Peter J Watkinson
- Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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Westphal GA, Pereira AB, Fachin SM, Sperotto G, Gonçalves M, Albino L, Bittencourt R, Franzini VDR, Koenig Á. An electronic warning system helps reduce the time to diagnosis of sepsis. Rev Bras Ter Intensiva 2018; 30:414-422. [PMID: 30570029 PMCID: PMC6334482 DOI: 10.5935/0103-507x.20180059] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/30/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To describe the improvements of an early warning system for the identification of septic patients on the time to diagnosis, antibiotic delivery, and mortality. METHODS This was an observational cohort study that describes the successive improvements made over a period of 10 years using an early warning system to detect sepsis, including systematic active manual surveillance, electronic alerts via a telephonist, and alerts sent directly to the mobile devices of nurses. For all periods, after an alert was triggered, early treatment was instituted according to the institutional sepsis guidelines. RESULTS In total, 637 patients with sepsis were detected over the study period. The median triage-to-diagnosis time was reduced from 19:20 (9:10 - 38:15) hours to 12:40 (2:50 - 23:45) hours when the manual surveillance method was used (p = 0.14), to 2:10 (1:25 - 2:20) hours when the alert was sent automatically to the hospital telephone service (p = 0.014), and to 1:00 (0:30 - 1:10) hour when the alert was sent directly to the nurse's mobile phone (p = 0.016). The diagnosis-to-antibiotic time was reduced to 1:00 (0:55 - 1:30) hours when the alert was sent to the telephonist and to 0:45 (0:30 - 1:00) minutes when the alert was sent directly to the nurse's mobile phone (p = 0.02), with the maintenance of similar values over the following years. There was no difference in the time of treatment between survivors and non-survivors. CONCLUSION Electronic systems help reduce the triage-to-diagnosis time and diagnosis-to-antibiotic time in patients with sepsis.
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Jabaley CS, Groff RF, Stentz MJ, Moll V, Lynde GC, Blum JM, O'Reilly-Shah VN. Highly visible sepsis publications from 2012 to 2017: Analysis and comparison of altmetrics and bibliometrics. J Crit Care 2018; 48:357-371. [PMID: 30296750 DOI: 10.1016/j.jcrc.2018.09.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE We sought to delineate highly visible publications related to sepsis. Within these subsets, elements of altmetrics performance, including mentions on Twitter, and the correlation between altmetrics and conventional citation counts were ascertained. MATERIALS AND METHODS Three subsets of sepsis publications from 2012 to 2017 were synthesized by the overall Altmetric.com attention score, number of mentions by unique Twitter users, and conventional citation counts. For these subsets, geolocated Twitter activity was plotted on a choropleth, the lag between publication date and altmetrics mentions was characterized, and correlations were examined between altmetrics performance and normalized conventional citation counts. RESULTS Of 57,152 PubMed query results, Altmetric.com data was available for 28,344 (49.6%). The top 50 publications by Altmetric.com attention score and Twitter attention represented a mix of original research and other types of work, garnering attention from Twitter users in 143 countries that was highly contemporaneous with publication. Altmetrics performance and conventional citation counts were poorly correlated. CONCLUSIONS While unreliable to gauge impact or future citation potential, altmetrics may be valuable for parties who wish to detect and drive public awareness of research findings and may enable researchers to dynamically explore the reach of their work in novel dimensions.
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Affiliation(s)
- Craig S Jabaley
- Department of Anesthesiology, Emory University, 1750 Gambrell Dr, Atlanta, GA 30322, USA; Anesthesiology Service Line, Division of Critical Care Medicine, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd, Decatur, GA 30033, USA.
| | - Robert F Groff
- Department of Anesthesiology, Emory University, 1750 Gambrell Dr, Atlanta, GA 30322, USA; Anesthesiology Service Line, Division of Critical Care Medicine, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd, Decatur, GA 30033, USA.
| | - Michael J Stentz
- Department of Anesthesiology, Emory University, 1750 Gambrell Dr, Atlanta, GA 30322, USA.
| | - Vanessa Moll
- Department of Anesthesiology, Emory University, 1750 Gambrell Dr, Atlanta, GA 30322, USA.
| | - Grant C Lynde
- Department of Anesthesiology, Emory University, 1750 Gambrell Dr, Atlanta, GA 30322, USA.
| | - James M Blum
- Department of Anesthesiology, Emory University, 1750 Gambrell Dr, Atlanta, GA 30322, USA; Anesthesiology Service Line, Division of Critical Care Medicine, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd, Decatur, GA 30033, USA; Department of Biomedical Informatics, Emory University School of Medicine, 201 Bowman Dr, Atlanta, GA 30322, USA.
| | - Vikas N O'Reilly-Shah
- Department of Anesthesiology, Emory University, 1750 Gambrell Dr, Atlanta, GA 30322, USA; Department of Anesthesiology, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA 30329, USA.
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Identifying Hesitation and Discomfort with Diagnosing Sepsis: Survey of a Pediatric Tertiary Care Center. Pediatr Qual Saf 2018; 3:e099. [PMID: 30584626 PMCID: PMC6221587 DOI: 10.1097/pq9.0000000000000099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/18/2018] [Indexed: 12/30/2022] Open
Abstract
Supplemental Digital Content is available in the text. Objective: Pediatric sepsis remains a significant cause of morbidity and mortality despite the development of strategies proven to improve diagnosis and treatment. Specifically, early recognition and urgent therapy initiation are consistently associated with improved outcomes. However, providers bring these principles inconsistently to the bedside. The objective of this study was to describe practitioner knowledge of, and attitudes toward, sepsis as a means of identifying potentially modifiable factors delaying life-saving treatment. We hypothesized there would be difficulties with sepsis recognition and self-reported discomfort with making the diagnosis among all provider groups in a pediatric tertiary care center. Methods: Emergency department and inpatient pediatric physicians, nurses, and respiratory therapists in a single, freestanding children’s hospital received an electronic survey. Likert scales permitted anonymous self-reporting of comfort and diagnostic delays. Seven clinical vignettes assessed diagnostic knowledge. Independent sample t tests and Chi-square compared responses. Results: Three hundred two staff participated (73% response rate), 41% of whom had at least 10 years of clinical experience. One in 5 was uncomfortable alerting coworkers to a patient with suspected sepsis or septic shock, and almost half were uncomfortable doing so in cases of compensated shock. Every role self-reported diagnostic delays, including faculty physicians. On average, physicians answered a greater percentage of vignette questions correctly (66%), compared with nurses (58%; P = 0.013) and respiratory therapists (52%; P = 0.005). Conclusions: Sepsis knowledge deficits, provider discomfort, and diagnostic delays are prevalent within a tertiary care children’s hospital. Their presence and scale suggest areas for future research and targeted intervention.
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Leon L, Kramer N, Ganti L, Amico K, Dub L, Lebowitz D, Rosario J, Ballinger B. Sepsis Cards and Facts: A Simple Way to Increase Sepsis Bundle Compliance. Cureus 2018; 10:e3245. [PMID: 30937226 PMCID: PMC6435005 DOI: 10.7759/cureus.3245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective The objective of this study was to improve sepsis bundle compliance via an educational intervention in our emergency department (ED). Methods This was a before and after study. Historical data on sepsis bundle compliance was obtained from our quality officer. Data were collected for 30 consecutive days to compare sepsis bundle compliance rates before and after the intervention. Descriptive statistics were compiled, and the z-test for proportions was used to calculate statistical significance. The intervention was two-fold: 1) a bright yellow card with sepsis criteria listed was posted on all ED workstation computers and 2) there was a daily email blast for one month with “sepsis facts.” These email blasts were short pearls that highlighted the importance of recognizing and treating sepsis. Results The sepsis bundle compliance rates in the month prior to the intervention was 38%. In the month during the targeted intervention, the compliance rate increased to 56%. There was a statistically significant increase in bundle compliance rates during the intervention (p=0.0399). We also administered a survey to the ED attendings and residents following the completion of the study to assess whether they perceived that our intervention was helping them increase compliance with ordering the sepsis bundle. The response rate was 94%. To the question “Did you feel the sepsis cards placed on the workstations make you more likely to consider sepsis earlier in patients under your care in the emergency department?” 70% answered agree or strongly agree. To the question “Were you more likely to order the sepsis bundle after receiving the daily "Sepsis Facts"?” 29% were neutral while 59% answered agree or strongly agree. Finally, to the question “Did you feel the sepsis cards and "sepsis facts" help you improve the care of Septic patients in the emergency department?” 76% answered agree or strongly agree. Conclusion Sepsis criteria reminders and email blasts highlighting the importance of treating and recognizing sepsis can improve compliance with sepsis bundle ordering within the emergency department.
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Affiliation(s)
- Leoh Leon
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Nicholas Kramer
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Latha Ganti
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Kendra Amico
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Larissa Dub
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - David Lebowitz
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Javier Rosario
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Bethany Ballinger
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
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Comparison of Sepsis-3 Criteria Versus SIRS Criteria in Screening Patients for Sepsis in the Emergency Department. Adv Emerg Nurs J 2018; 40:138-143. [DOI: 10.1097/tme.0000000000000187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gleason KT, Davidson PM, Tanner EK, Baptiste D, Rushton C, Day J, Sawyer M, Baker D, Paine L, Himmelfarb CRD, Newman-Toker DE. Defining the critical role of nurses in diagnostic error prevention: a conceptual framework and a call to action. Diagnosis (Berl) 2017. [DOI: 10.1515/dx-2017-0015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractNurses have always been involved in the diagnostic process, but there remains a pervasive view across physicians, nurses, and allied health professionals that medical diagnosis is solely a physician responsibility. There is an urgent need to adjust this view and for nurses to take part in leading efforts addressing diagnostic errors. The purpose of this article is to define a framework for nursing engagement in the diagnostic process that can serve as a catalyst for nurses to engage in eliminating preventable harms from diagnostic error. We offer a conceptual model to formalize and expand nurses’ engagement in the diagnostic process through education, maximize effectiveness of interprofessional teamwork and communication through culture change, and leverage the nursing mission to empower patients to become active members of the diagnostic team. We describe the primary barriers, including culture, education, operations, and regulations, to nurses participating as full, equal members of the diagnostic team, and illustrate our approach to addressing these barriers. Nurses already play a major role in diagnosis and increasingly take ownership of this role, removing barriers will strengthen nurses’ ability to be equal, integral diagnostic team members. This model should serve as a foundation for increasing the role of the nurse in the diagnostic process, and calling nurses to take action in leading efforts to reduce diagnostic error.
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Zaccone V, Tosoni A, Passaro G, Vallone CV, Impagnatiello M, Li Puma DD, De Cosmo S, Landolfi R, Mirijello A. Sepsis in Internal Medicine wards: current knowledge, uncertainties and new approaches for management optimization. Ann Med 2017; 49:582-592. [PMID: 28521523 DOI: 10.1080/07853890.2017.1332776] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Sepsis represents a global health problem in terms of morbidity, mortality, social and economic costs. Although usually managed in Intensive Care Units, sepsis showed an increased prevalence among Internal Medicine wards in the last decade. This is substantially due to the ageing of population and to multi-morbidity. These characteristics represent both a risk factor for sepsis and a relative contra-indication for the admission to Intensive Care Units. Although there is a lack of literature on the management of sepsis in Internal Medicine, the outcome of these patients seems to be gradually improving. This is due to Internists' increased adherence to guidelines and "bundles". The routine use of SOFA score helps physicians in the definition of septic patients, even if the optimal score has still to come. Point-of-care ultrasonography, lactates, procalcitonin and beta-d-glucan are of help for treatment optimization. The purpose of this narrative review is to focus on the management of sepsis in Internal Medicine departments, particularly on crucial concepts regarding diagnosis, risk assessment and treatment. Key Messages Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The prevalence of sepsis is constantly increasing, affecting more hospital patients than any other disease. At least half of patients affected by sepsis are admitted to Internal Medicine wards. Adherence to guidelines, routine use of clinical and lab scores and point-of-care ultrasonography are of help for early recognition of septic patients and treatment optimization.
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Affiliation(s)
- Vincenzo Zaccone
- a Department of Medical Sciences , Gemelli Hospital, Catholic University of Rome , Rome , Italy
| | - Alberto Tosoni
- a Department of Medical Sciences , Gemelli Hospital, Catholic University of Rome , Rome , Italy
| | - Giovanna Passaro
- a Department of Medical Sciences , Gemelli Hospital, Catholic University of Rome , Rome , Italy
| | - Carla Vincenza Vallone
- a Department of Medical Sciences , Gemelli Hospital, Catholic University of Rome , Rome , Italy
| | - Michele Impagnatiello
- a Department of Medical Sciences , Gemelli Hospital, Catholic University of Rome , Rome , Italy
| | | | - Salvatore De Cosmo
- c Department of Medical Sciences , IRCCS Casa Sollievo della Sofferenza Hospital , San Giovanni Rotondo , Italy
| | - Raffaele Landolfi
- a Department of Medical Sciences , Gemelli Hospital, Catholic University of Rome , Rome , Italy
| | - Antonio Mirijello
- a Department of Medical Sciences , Gemelli Hospital, Catholic University of Rome , Rome , Italy.,c Department of Medical Sciences , IRCCS Casa Sollievo della Sofferenza Hospital , San Giovanni Rotondo , Italy
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Hovlid E, Frich JC, Walshe K, Nilsen RM, Flaatten HK, Braut GS, Helgeland J, Teig IL, Harthug S. Effects of external inspection on sepsis detection and treatment: a study protocol for a quasiexperimental study with a stepped-wedge design. BMJ Open 2017; 7:e016213. [PMID: 28877944 PMCID: PMC5589010 DOI: 10.1136/bmjopen-2017-016213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Inspections are widely used in health care as a means to improve the health services delivered to patients. Despite their widespread use, there is little evidence of their effect. The mechanisms for how inspections can promote change are poorly understood. In this study, we use a national inspection campaign of sepsis detection and initial treatment in hospitals as case to: (1) Explore how inspections affect the involved organizations. (2) Evaluate what effect external inspections have on the process of delivering care to patients, measured by change in indicators reflecting how sepsis detection and treatment is carried out. (3) Evaluate whether external inspections affect patient outcomes, measured as change in the 30-day mortality rate and length of hospital stay. METHODS AND ANALYSIS The intervention that we study is inspections of sepsis detection and treatment in hospitals. The intervention will be rolled out sequentially during 12 months to 24 hospitals. Our effect measures are change on indicators related to the detection and treatment of sepsis, the 30-day mortality rate and length of hospital stay. We collect data from patient records at baseline, before the inspections, and at 8 and 14 months after the inspections. We use logistic regression models and linear regression models to compare the various effect measurements between the intervention and control periods. All the models will include time as a covariate to adjust for potential secular changes in the effect measurements during the study period. We collect qualitative data before and after the inspections, and we will conduct a thematic content analysis to explore how inspections affect the involved organisations. ETHICS AND DISSEMINATION The study has obtained ethical approval by the Regional Ethics Committee of Norway Nord and the Norwegian Data Protection Authority. It is registered at www.clinicaltrials.gov (Identifier: NCT02747121). Results will be reported in international peer-reviewed journals. TRIAL REGISTRATION NCT02747121; Pre-results.
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Affiliation(s)
- Einar Hovlid
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal and Norwegian Board of Health Supervision, Oslo, Norway
| | - Jan C Frich
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kieran Walshe
- Health Management Group, Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Roy M Nilsen
- Department of Health and Social Sciences, Department of Research and Development, Western Norway University of Applied Sciences, Haukeland University Hospital, Bergen, Norway
| | - Hans Kristian Flaatten
- Department of Anaesthesia and Intensive Care, Department of Clinical Medicine, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Geir Sverre Braut
- Department of research, Stavanger University Hospital, Stavanger; Norwegian Board of Health Supervision, Oslo, Norway
| | - Jon Helgeland
- Quality Measurement Unit, Norwegian Institute of Public Health, Oslo, Norway
| | - Inger Lise Teig
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stig Harthug
- Department of Research and Development, Department of Clinical Science, Faculty of Medicine and Dentistry, Haukeland University Hospital, University of Bergen, Bergen, Norway
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Askim Å, Moser F, Gustad LT, Stene H, Gundersen M, Åsvold BO, Dale J, Bjørnsen LP, Damås JK, Solligård E. Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality - a prospective study of patients admitted with infection to the emergency department. Scand J Trauma Resusc Emerg Med 2017; 25:56. [PMID: 28599661 PMCID: PMC5466747 DOI: 10.1186/s13049-017-0399-4] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/26/2017] [Indexed: 02/06/2023] Open
Abstract
Background We aimed to evaluate the clinical usefulness of qSOFA as a risk stratification tool for patients admitted with infection compared to traditional SIRS criteria or our triage system; the Rapid Emergency Triage and Treatment System (RETTS). Methods The study was an observational cohort study performed at one Emergency Department (ED) in an urban university teaching hospital in Norway, with approximately 20,000 visits per year. All patients >16 years presenting with symptoms or clinical signs suggesting an infection (n = 1535) were prospectively included in the study from January 1 to December 31, 2012. At arrival in the ED, vital signs were recorded and all patients were triaged according to RETTS vital signs, presenting infection, and sepsis symptoms. These admission data were also used to calculate qSOFA and SIRS. Treatment outcome was later retrieved from the patients’ electronic records (EPR) and mortality data from the Norwegian population registry. Results Of the 1535 admitted patients, 108 (7.0%) fulfilled the Sepsis2 criteria for severe sepsis. The qSOFA score ≥2 identified only 33 (sensitivity 0.32, specificity 0.98) of the patients with severe sepsis, whilst the RETTS-alert ≥ orange identified 92 patients (sensitivity 0.85, specificity 0.55). Twenty-six patients died within 7 days of admission; four (15.4%) of them had a qSOFA ≥2, and 16 (61.5%) had RETTS ≥ orange alert. Of the 68 patients that died within 30 days, only eight (11.9%) scored ≥2 on the qSOFA, and 45 (66.1%) had a RETTS ≥ orange alert. Discussion In order to achieve timely treatment for sepsis, a sensitive screening tool is more important than a specific one. Our study is the fourth study were qSOFA finds few of the sepsis cases in prehospital or at arrival to the ED. We add information on the RETTS triage system, the two highest acuity levels together had a high sensitivity (85%) for identifying sepsis at arrival to the ED - and thus, RETTS should not be replaced by qSOFA as a screening and trigger tool for sepsis at arrival. Conclusion In this observational cohort study, qSOFA failed to identify two thirds of the patients admitted to an ED with severe sepsis. Further, qSOFA failed to be a risk stratification tool as the sensitivity to predict 7-day and 30-day mortality was low. The sensitivity was poorer than the other warning scores already in use at the study site, RETTS-triage and the SIRS criteria. Electronic supplementary material The online version of this article (doi:10.1186/s13049-017-0399-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Åsa Askim
- Clinic of Anesthesia and Intensive Care, St Olav University Hospital, Trondheim, Norway. .,Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Po box 8905, N-7491, Trondheim, Norway. .,Mid- Norway Sepsis Research Center, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Florentin Moser
- Clinic of Emergency Medicine and Prehospital Services, St Olav University Hospital, Trondheim, Norway
| | - Lise T Gustad
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Po box 8905, N-7491, Trondheim, Norway.,Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,Mid- Norway Sepsis Research Center, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Helga Stene
- Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Maren Gundersen
- Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjørn Olav Åsvold
- Department of Endocrinology, St Olav University Hospital, Trondheim, Norway.,Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Mid- Norway Sepsis Research Center, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jostein Dale
- Clinic of Emergency Medicine and Prehospital Services, St Olav University Hospital, Trondheim, Norway
| | - Lars Petter Bjørnsen
- Clinic of Emergency Medicine and Prehospital Services, St Olav University Hospital, Trondheim, Norway
| | - Jan Kristian Damås
- Department of Infectious Diseases, St Olav University Hospital, Trondheim, Norway.,Centre of Molecular Inflammation Research of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Mid- Norway Sepsis Research Center, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erik Solligård
- Clinic of Anesthesia and Intensive Care, St Olav University Hospital, Trondheim, Norway.,Clinic of Emergency Medicine and Prehospital Services, St Olav University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Po box 8905, N-7491, Trondheim, Norway.,Mid- Norway Sepsis Research Center, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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Calvert J, Hoffman J, Barton C, Shimabukuro D, Ries M, Chettipally U, Kerem Y, Jay M, Mataraso S, Das R. Cost and mortality impact of an algorithm-driven sepsis prediction system. J Med Econ 2017; 20:646-651. [PMID: 28294646 DOI: 10.1080/13696998.2017.1307203] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS To compute the financial and mortality impact of InSight, an algorithm-driven biomarker, which forecasts the onset of sepsis with minimal use of electronic health record data. METHODS This study compares InSight with existing sepsis screening tools and computes the differential life and cost savings associated with its use in the inpatient setting. To do so, mortality reduction is obtained from an increase in the number of sepsis cases correctly identified by InSight. Early sepsis detection by InSight is also associated with a reduction in length-of-stay, from which cost savings are directly computed. RESULTS InSight identifies more true positive cases of severe sepsis, with fewer false alarms, than comparable methods. For an individual ICU with 50 beds, for example, it is determined that InSight annually saves 75 additional lives and reduces sepsis-related costs by $560,000. LIMITATIONS InSight performance results are derived from analysis of a single-center cohort. Mortality reduction results rely on a simplified use case, which fixes prediction times at 0, 1, and 2 h before sepsis onset, likely leading to under-estimates of lives saved. The corresponding cost reduction numbers are based on national averages for daily patient length-of-stay cost. CONCLUSIONS InSight has the potential to reduce sepsis-related deaths and to lead to substantial cost savings for healthcare facilities.
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Affiliation(s)
| | | | - Christopher Barton
- b Department of Emergency Medicine , University of California San Francisco , San Francisco , CA , USA
| | - David Shimabukuro
- c Division of Critical Care Medicine, Department of Anesthesia and Perioperative Care , University of California San Francisco , San Francisco , CA , USA
| | - Michael Ries
- d Adult Critical Care, Advocate Health , Oak Brook , IL , USA
| | - Uli Chettipally
- b Department of Emergency Medicine , University of California San Francisco , San Francisco , CA , USA
- e Department of Emergency Medicine , Kaiser Permanente South San Francisco Medical Center , South San Francisco , CA , USA
| | - Yaniv Kerem
- f Department of Clinical Informatics, Stanford University School of Medicine , Stanford , CA , USA
- g Department of Emergency Medicine , Kaiser Permanente Redwood City Medical Center , Redwood City , CA , USA
| | | | - Samson Mataraso
- h Department of Bioengineering , University of California Berkeley , Berkeley , CA , USA
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Mehl A, Åsvold BO, Lydersen S, Paulsen J, Solligård E, Damås JK, Harthug S, Edna TH. Burden of bloodstream infection in an area of Mid-Norway 2002-2013: a prospective population-based observational study. BMC Infect Dis 2017; 17:205. [PMID: 28284196 PMCID: PMC5346205 DOI: 10.1186/s12879-017-2291-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/24/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Studies from several countries indicate that the incidence and mortality of bloodstream infection (BSI) have been increasing over time. METHODS We studied the burden of disease and death related to BSI in a defined geographical area of Mid-Norway, where BSI episodes were prospectively recorded by the same microbiological department during 12 consecutive years. Death from BSI was defined as death within 30 days of BSI detection. Age and sex standardized incidence and mortality rates and case fatality rates were calculated. RESULTS Between 2002 and 2013, 1995 episodes of BSI in 1719 patients aged 16 to 99 years were included. The overall incidence of BSI was 215 per 100,000 person-years. The incidence increased exponentially with age, particularly in males. The incidence increased from 205 to 223 per 100,000 person-years from 2002-07 to 2008-13. Escherichia coli was the most frequently isolated infective agent, followed by Streptococcus pneumoniae and Staphylococcus aureus. The rate of S. pneumoniae BSI decreased over time in males (on average by 9.2% annually), but not in females. The total rate of BSI microbes with acquired resistance increased slightly over time, but did not exceed 2 episodes per 100,000 person-years. The mortality of BSI was 32 per 100,000 person-years, higher in males than in females (36 vs. 28 per 100,000 person-years) and was significantly higher in old age, particularly in males. The total BSI mortality was similar in the first and second halves of the study period, but the mortality of S. pneumoniae BSI decreased in males (15.0% annually). The crude case fatality decreased from the first to the second half of the study period (17.2% to 13.1%; p = 0.014). The rate of blood culture sampling increased more than twofold during the study period. CONCLUSIONS The mortality of BSI remained stable during 2002-2013. At the same time, BSI incidence increased and case fatality rate decreased, perhaps because an increased rate of blood culture sampling may have led to improved detection of milder BSI episodes. Very low, yet slightly increasing rates of microbes with acquired resistance were observed.
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Affiliation(s)
- Arne Mehl
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, post box 333, Levanger, N-7601, Norway. .,Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway. .,Mid-Norway Sepsis Research Group, Faculty of Medicine, NTNU, Trondheim, Norway.
| | - Bjørn Olav Åsvold
- Mid-Norway Sepsis Research Group, Faculty of Medicine, NTNU, Trondheim, Norway.,Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Endocrinology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Julie Paulsen
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, post box 333, Levanger, N-7601, Norway.,Mid-Norway Sepsis Research Group, Faculty of Medicine, NTNU, Trondheim, Norway.,Centre of Molecular Inflammation Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erik Solligård
- Mid-Norway Sepsis Research Group, Faculty of Medicine, NTNU, Trondheim, Norway.,Clinic of Anaesthesia and Intensive Care, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jan Kristian Damås
- Mid-Norway Sepsis Research Group, Faculty of Medicine, NTNU, Trondheim, Norway.,Centre of Molecular Inflammation Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Infectious Diseases, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stig Harthug
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Tom-Harald Edna
- Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Vincent JL. The challenge of early identification of the hospital patient at risk of septic complications. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:56. [PMID: 28251135 DOI: 10.21037/atm.2017.01.49] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium
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Kleinpell R. Promoting early identification of sepsis in hospitalized patients with nurse-led protocols. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:10. [PMID: 28073375 PMCID: PMC5225612 DOI: 10.1186/s13054-016-1590-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Bridges E, McNeill MM, Munro N. Research in Review: Advancing Critical Care Practice. Am J Crit Care 2016; 26:77-88. [PMID: 27965233 DOI: 10.4037/ajcc2017609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Research published in 2016 identified strategies to enhance acute and critical care, initiated discussions on professional roles and responsibilities, clarified complex care issues, and led to robust debate. Some of this important work addressed strategies to prevent delirium and pressure ulcers, considerations for pain management within the context of the opioid abuse crisis, strategies to guide fluid resuscitation in patients with sepsis and heart failure, and ways to enhance care for family members of intensive care patients. The new sepsis definitions highlight the importance of detecting and providing care to patients with sepsis outside of critical care areas. Chimeric antigen receptor T-cell therapy is an example of the advancement of research in genomics and personalized medicine and of the need to understand the care implications of these therapies. Other research topics include interprofessional collaboration and shared decision-making as well as nurses' role in family conferences. Resources such as policies related to medical futility and inappropriate care and the American Association of Critical-Care Nurses' healthy work environment standards may inform conversations and provide strategies to address these complex issues.
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Affiliation(s)
- Elizabeth Bridges
- Elizabeth Bridges is a professor at University of Washington School of Nursing and a clinical nurse researcher at University of Washington Medical Center, Seattle, Washington. Margaret M. McNeill is a clinical nurse specialist, perianesthesia, Frederick Regional Health System, Frederick, Maryland. Nancy Munro is a senior acute care nurse practitioner, National Institutes of Health, Bethesda, Maryland
| | - Margaret M. McNeill
- Elizabeth Bridges is a professor at University of Washington School of Nursing and a clinical nurse researcher at University of Washington Medical Center, Seattle, Washington. Margaret M. McNeill is a clinical nurse specialist, perianesthesia, Frederick Regional Health System, Frederick, Maryland. Nancy Munro is a senior acute care nurse practitioner, National Institutes of Health, Bethesda, Maryland
| | - Nancy Munro
- Elizabeth Bridges is a professor at University of Washington School of Nursing and a clinical nurse researcher at University of Washington Medical Center, Seattle, Washington. Margaret M. McNeill is a clinical nurse specialist, perianesthesia, Frederick Regional Health System, Frederick, Maryland. Nancy Munro is a senior acute care nurse practitioner, National Institutes of Health, Bethesda, Maryland
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