Impact of the diagnostic process on the accuracy of source identification and time to antibiotics in septic emergency department patients

2014 ◽  
Vol 21 (3) ◽  
pp. 212-219 ◽  
Author(s):  
Annemieke J.M. Uittenbogaard ◽  
Ernie R.J.T. de Deckere ◽  
Maro H. Sandel ◽  
Alice Vis ◽  
Christine M. Houser ◽  
...  
Keyword(s):  
Emergency Department ◽  
Source Identification ◽  
Diagnostic Process ◽  
Time To Antibiotics ◽  
Emergency Department Patients

Sepsis

2019 ◽  
Author(s):  
Michael R. Filbin
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Lactate Production ◽  
Scoring Systems ◽  
Mortality Prediction ◽  
Lengths Of Stay ◽  
Organ Failures ◽  
Hospital Deaths ◽  
Time To Antibiotics ◽  
Emergency Department Patients

Sepsis accounts for approximately one in three hospital deaths, and is associated with very high health care costs due to prolonged lengths of stay in the intensive care unit and hospital. Sepsis is essentially an immunologic response to infection that is propagated systemically, leading to diffuse cellular and microcirculatory dysfunction, vasodilation, vital organ hypoperfusion, and eventual failure. This review covers the pathophysiology, stabilization/assessment, diagnosis, treatment, and disposition and outcomes of sepsis. Figures show the inflammatory and thrombotic response to infection, the action of nitric oxide on vascular smooth muscle cells, accelerated glycolysis and increased lactate production as a result of the catecholamine surge seen in septic shock, sepsis mortality associated with number of organ failures identified in the emergency department (ED), and protocolized therapy for septic shock. Tables list definitions of sepsis syndromes; frequently cited scoring systems for mortality prediction in emergency department patients with sepsis; Sequential Organ Failure Assessment (SOFA) score; current recommendations regarding treatment bundles at 3 and 6 hours of resuscitation; antibiotic recommendations based on suspected source; and vasopressors used in septic shock with recommended dosing, mechanism of action, and indications. This review contains 5 figures, 7 tables, and 57 references. Keywords: Sepsis; Surviving Sepsis Campaign guidelines, definitions, SEP-1 sepsis quality measure, time-to-antibiotics, volume resuscitation, lactated ringers

Sepsis

2018 ◽  
Author(s):  
Michael R. Filbin
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Lactate Production ◽  
Scoring Systems ◽  
Mortality Prediction ◽  
Lengths Of Stay ◽  
Organ Failures ◽  
Hospital Deaths ◽  
Time To Antibiotics ◽  
Emergency Department Patients

Sepsis accounts for approximately one in three hospital deaths, and is associated with very high health care costs due to prolonged lengths of stay in the intensive care unit and hospital. Sepsis is essentially an immunologic response to infection that is propagated systemically, leading to diffuse cellular and microcirculatory dysfunction, vasodilation, vital organ hypoperfusion, and eventual failure. This review covers the pathophysiology, stabilization/assessment, diagnosis, treatment, and disposition and outcomes of sepsis. Figures show the inflammatory and thrombotic response to infection, the action of nitric oxide on vascular smooth muscle cells, accelerated glycolysis and increased lactate production as a result of the catecholamine surge seen in septic shock, sepsis mortality associated with number of organ failures identified in the emergency department (ED), and protocolized therapy for septic shock. Tables list definitions of sepsis syndromes; frequently cited scoring systems for mortality prediction in emergency department patients with sepsis; Sequential Organ Failure Assessment (SOFA) score; current recommendations regarding treatment bundles at 3 and 6 hours of resuscitation; antibiotic recommendations based on suspected source; and vasopressors used in septic shock with recommended dosing, mechanism of action, and indications. This review contains 5 figures, 7 tables, and 57 references. Keywords: Sepsis; Surviving Sepsis Campaign guidelines, definitions, SEP-1 sepsis quality measure, time-to-antibiotics, volume resuscitation, lactated ringers  

Sepsis

2019 ◽  
Author(s):  
Michael R. Filbin
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Lactate Production ◽  
Scoring Systems ◽  
Mortality Prediction ◽  
Lengths Of Stay ◽  
Organ Failures ◽  
Hospital Deaths ◽  
Time To Antibiotics ◽  
Emergency Department Patients

Sepsis accounts for approximately one in three hospital deaths, and is associated with very high health care costs due to prolonged lengths of stay in the intensive care unit and hospital. Sepsis is essentially an immunologic response to infection that is propagated systemically, leading to diffuse cellular and microcirculatory dysfunction, vasodilation, vital organ hypoperfusion, and eventual failure. This review covers the pathophysiology, stabilization/assessment, diagnosis, treatment, and disposition and outcomes of sepsis. Figures show the inflammatory and thrombotic response to infection, the action of nitric oxide on vascular smooth muscle cells, accelerated glycolysis and increased lactate production as a result of the catecholamine surge seen in septic shock, sepsis mortality associated with number of organ failures identified in the emergency department (ED), and protocolized therapy for septic shock. Tables list definitions of sepsis syndromes; frequently cited scoring systems for mortality prediction in emergency department patients with sepsis; Sequential Organ Failure Assessment (SOFA) score; current recommendations regarding treatment bundles at 3 and 6 hours of resuscitation; antibiotic recommendations based on suspected source; and vasopressors used in septic shock with recommended dosing, mechanism of action, and indications. This review contains 5 figures, 7 tables, and 57 references. Keywords: Sepsis; Surviving Sepsis Campaign guidelines, definitions, SEP-1 sepsis quality measure, time-to-antibiotics, volume resuscitation, lactated ringers

Sepsis

2019 ◽  
Author(s):  
Michael R. Filbin
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Lactate Production ◽  
Scoring Systems ◽  
Mortality Prediction ◽  
Lengths Of Stay ◽  
Organ Failures ◽  
Hospital Deaths ◽  
Time To Antibiotics ◽  
Emergency Department Patients

Sepsis accounts for approximately one in three hospital deaths, and is associated with very high health care costs due to prolonged lengths of stay in the intensive care unit and hospital. Sepsis is essentially an immunologic response to infection that is propagated systemically, leading to diffuse cellular and microcirculatory dysfunction, vasodilation, vital organ hypoperfusion, and eventual failure. This review covers the pathophysiology, stabilization/assessment, diagnosis, treatment, and disposition and outcomes of sepsis. Figures show the inflammatory and thrombotic response to infection, the action of nitric oxide on vascular smooth muscle cells, accelerated glycolysis and increased lactate production as a result of the catecholamine surge seen in septic shock, sepsis mortality associated with number of organ failures identified in the emergency department (ED), and protocolized therapy for septic shock. Tables list definitions of sepsis syndromes; frequently cited scoring systems for mortality prediction in emergency department patients with sepsis; Sequential Organ Failure Assessment (SOFA) score; current recommendations regarding treatment bundles at 3 and 6 hours of resuscitation; antibiotic recommendations based on suspected source; and vasopressors used in septic shock with recommended dosing, mechanism of action, and indications. This review contains 5 figures, 7 tables, and 57 references. Keywords: Sepsis; Surviving Sepsis Campaign guidelines, definitions, SEP-1 sepsis quality measure, time-to-antibiotics, volume resuscitation, lactated ringers

Abstract 253: Abstract: Self-advocacy in the Diagnostic Process Among Emergency Department Patients: A Qualitative Study

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Paula Emille C Bondal ◽  
Mariel Villanueva ◽  
Kelly T Gleason
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Qualitative Study ◽  
Clinical Care ◽  
Diagnostic Process ◽  
Self Awareness ◽  
Self Advocacy ◽  
Emergency Department Patients ◽  
High Level ◽  
Health Situation

Background: Evidence suggests that including the patient in the decision-making process leads to better health outcomes. The objective of this qualitative study is to explore barriers and facilitators to self-advocacy among patients during the diagnostic process in the emergency department (ED). Methods: ED patients (n=16) completed 15-30 minute semi-structured phone interviews 2 weeks to 3 months following an ED visit. Patients were eligible who had at least one chief complaint linked to common, dangerous cardiovascular conditions that are often misdiagnosed (chest pain, dizziness, headache, abdominal pain, and/or cough). Interviews were transcribed verbatim and coded by two independent reviewers using an inductive thematic analysis approach. Findings: The participants’ average age was 51 years-old (range 26-73 years-old). 62.5% of participants identified their race as White, 37.5% Black or African American, and 6.2% Asian. Interviews centered on the patients’ experience with the diagnostic process in the ED, including expectations, communication with clinical care team, and satisfaction and understanding of follow-up plans. The analysis revealed three common themes: (1) Doctors perceived as having total authority. Patients voiced that they must do as prescribed and not question the explanation given for their health problems by the doctors, who were the experts. (2) Satisfaction without a thorough assessment. Patients reported an acceptance of being “rushed” from the ED without thorough diagnosis or explanation because they expect doctors to be busy. Patients are satisfied with being told their diagnosis is unknown but not life-threatening. (3) Patients reported a high-level of self-awareness of their baseline health status, and used their intuition to seek medical care. Three of the sixteen patients reported developing a dangerous cardiovascular condition, including a stroke and a venous thromboembolism, after discharge that potentially could have been identified in the ED. They each reported a self-awareness that a dangerous health situation may be developing, but a trust in providers’ decision-making to discharge them. Conclusions: The interviews shared common themes of reduced self-advocacy in the setting of the ED and trust in providers’ opinions over patients’ own intuition. In three cases, patients reported developing a dangerous cardiovascular condition shortly after discharge that may have been identified earlier with increased self-advocacy.Implications for Practice: The fast-paced ED system may exacerbate patient vulnerability and impede their willingness to assert themselves. Empowering patients to provide input in the diagnostic process may contribute valuable information that leads to more accurate diagnoses.

Sepsis

2018 ◽  
Author(s):  
Michael R. Filbin
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Lactate Production ◽  
Scoring Systems ◽  
Mortality Prediction ◽  
Lengths Of Stay ◽  
Organ Failures ◽  
Hospital Deaths ◽  
Time To Antibiotics ◽  
Emergency Department Patients

Sepsis accounts for approximately one in three hospital deaths, and is associated with very high health care costs due to prolonged lengths of stay in the intensive care unit and hospital. Sepsis is essentially an immunologic response to infection that is propagated systemically, leading to diffuse cellular and microcirculatory dysfunction, vasodilation, vital organ hypoperfusion, and eventual failure. This review covers the pathophysiology, stabilization/assessment, diagnosis, treatment, and disposition and outcomes of sepsis. Figures show the inflammatory and thrombotic response to infection, the action of nitric oxide on vascular smooth muscle cells, accelerated glycolysis and increased lactate production as a result of the catecholamine surge seen in septic shock, sepsis mortality associated with number of organ failures identified in the emergency department (ED), and protocolized therapy for septic shock. Tables list definitions of sepsis syndromes; frequently cited scoring systems for mortality prediction in emergency department patients with sepsis; Sequential Organ Failure Assessment (SOFA) score; current recommendations regarding treatment bundles at 3 and 6 hours of resuscitation; antibiotic recommendations based on suspected source; and vasopressors used in septic shock with recommended dosing, mechanism of action, and indications. This review contains 5 figures, 7 tables, and 57 references. Keywords: Sepsis; Surviving Sepsis Campaign guidelines, definitions, SEP-1 sepsis quality measure, time-to-antibiotics, volume resuscitation, lactated ringers

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