scholarly journals The Use of an Early Alert System to Improve Compliance with Sepsis Bundles and to Assess Impact on Mortality

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Jennifer Anne LaRosa ◽  
Noeen Ahmad ◽  
Monica Feinberg ◽  
Monica Shah ◽  
Roseann DiBrienza ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Screening Tool ◽  
Severity Of Illness ◽  
Antibiotic Administration ◽  
Alert System ◽  
Sepsis Management ◽  
Sepsis Bundles ◽  
Improve Compliance ◽  
Early Alert

Introduction. Diagnostic and therapeutic guidelines, organized as sepsis bundles, have been shown to improve mortality, but timely and consistent implementation of these can be challenging. Our study examined the use of a screening tool and an early alert system to improve bundle compliance and mortality.Methods. A screening tool was used to identify patients with severe sepsis or septic shock and an overhead alert system known as Code SMART (Sepsis Management Alert Response Team) was activated at the physician’s discretion. Data was collected for 6 months and compliance with bundle completion and mortality were compared between the Code SMART and non-Code SMART groups.Results.Fifty eight patients were enrolled −34 Code SMART and 24 non-Code SMART. The Code SMART group achieved greater compliance with timely antibiotic administration (P<0.001), lactate draw (P<0.001), and steroid use (P=0.02). Raw survival and survival adjusted for age, leucopenia, and severity of illness scores, were greater in the Code SMART group (P<0.05,P=0.03, andP=0.01).Conclusions. A screening tool and an alert system can improve compliance with sepsis bundle elements and improve survival from severe sepsis and septic shock.

scholarly journals Additional Telemedicine Rounds as a Successful Performance-Improvement Strategy for Sepsis Management: Observational Multicenter Study (Preprint)

2018 ◽  
Author(s):  
Robert Deisz ◽  
Susanne Rademacher ◽  
Katrin Gilger ◽  
Rudolf Jegen ◽  
Barbara Sauerzapfe ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Length Of Stay ◽  
Performance Improvement ◽  
Multicenter Study ◽  
Sepsis Management ◽  
Sepsis Bundles ◽  
Improvement Programs ◽  
Sepsis And Septic Shock ◽  
Effective Component

BACKGROUND Sepsis is a major health care problem with high morbidity and mortality rates and affects millions of patients. Telemedicine, defined as the exchange of medical information via electronic communication, improves the outcome of patients with sepsis and decreases the mortality rate and length of stay in the intensive care unit (ICU). Additional telemedicine rounds could be an effective component of performance-improvement programs for sepsis, especially in underserved rural areas and hospitals without ready access to critical care physicians. OBJECTIVE Our aim was to evaluate the impact of additional daily telemedicine rounds on adherence to sepsis bundles. We hypothesized that additional telemedicine support may increase adherence to sepsis guidelines and improve the detection rates of sepsis and septic shock. METHODS We conducted a retrospective, observational, multicenter study between January 2014 and July 2015 with one tele-ICU center and three ICUs in Germany. We implemented telemedicine as part of standard care and collected data continuously during the study. During the daily telemedicine rounds, routine screening for sepsis was conducted and adherence to the Surviving Sepsis Campaign’s 3-hour and 6-hour sepsis bundles were evaluated. RESULTS In total, 1168 patients were included in this study, of which 196 were positive for severe sepsis and septic shock. We found that additional telemedicine rounds improved adherence to the 3-hour (Quarter 1, 35% vs Quarter 6, 76.2%; P=.01) and 6-hour (Quarter 1, 50% vs Quarter 6, 95.2%; P=.001) sepsis bundles. In addition, we noted an increase in adherence to the item “Administration of fluids when hypotension” (Quarter 1, 80% vs Quarter 6, 100%; P=.049) of the 3-hour bundle and the item “Remeasurement of lactate” (Quarter 1, 65% vs Quarter 6, 100%, P=.003) of the 6-hour bundle. The ICU length of stay after diagnosis of severe sepsis and septic shock remained unchanged over the observation period. Due to a higher number of patients with sepsis in Quarter 5 (N=60) than in other quarters, we observed stronger effects of the additional rounds on mortality in this quarter (Quarter 1, 50% vs Quarter 5, 23.33%, P=.046). CONCLUSIONS Additional telemedicine rounds are an effective component of and should be included in performance-improvement programs for sepsis management.

scholarly journals Differences in Hypotensive vs. Non-Hypotensive Sepsis Management in the Emergency Department: Door-to-Antibiotic Time Impact on Sepsis Survival

2018 ◽  
Vol 6 (4) ◽  
pp. 91
Author(s):  
Leonor Ballester ◽  
Rafael Martínez ◽  
Juan Méndez ◽  
Gloria Miró ◽  
Manel Solsona ◽  
...  
Keyword(s):  
Emergency Department ◽  
Severe Sepsis ◽  
Clinical Laboratory ◽  
University Hospital ◽  
Antibiotic Administration ◽  
Process Of Care ◽  
Sepsis Management ◽  
Initial Management ◽  
Sepsis Diagnosis ◽  
Community Onset

Background: Sepsis diagnosis can be incorrectly associated with the presence of hypotension during an infection, so the detection and management of non-hypotensive sepsis can be delayed. We aimed to evaluate how the presence or absence of hypotension, on admission at the emergency department, affects the initial management and outcomes of patients with community-onset severe sepsis. Methods: Demographic, clinical, laboratory, process of care, and outcome variables were recorded for all patients, at the emergency department of our university hospital, who presented with community-onset severe sepsis, between 1 March and 31 August in three consecutive years. Patient management consisted of standardized bundled care with five measures: Detection, blood cultures and empirical antibiotics, oxygen supplementation and fluid resuscitation (if needed), clinical monitoring, and noradrenalin administration (if needed). We compared all variables between patients who had hypotension (mean arterial pressure <65 mmHg), on admission to the emergency department, and those who did not. Results: We identified 153 episodes (84 (54.5%) men; mean age 73.6 ± 1.2; mean Sequential Organ Failure Assessment (SOFA) score 4.9 ± 2.7, and 41.2% hospital mortality). Hypotension was present on admission to the emergency department in 57 patients (37.2%). Hemodynamic treatment was applied earlier in patients who presented hypotension initially. Antibiotics were administered 48 min later in non-hypotensive sepsis (p = 0.08). A higher proportion of patients without initial hypotension required admission to the intensive care unit (ICU) (43.1% for patients initially hypotensive vs. 56.9% in those initially non-hypotensive, p < 0.05). Initial hypotension was not associated with mortality. A delay in door-to-antibiotic administration time was associated with mortality [OR 1.150, 95%CI: 1.043–1.268). Conclusions: Initial management of patients with community-onset severe sepsis differed according to their clinical presentation. Initial hypotension was associated with early hemodynamic management and less ICU requirement. A non-significant delay was observed in the administration of antibiotics to initially non-hypotensive patients. The time of door-to-antibiotic administration was related to mortality.

Sepsis

2020 ◽  
Author(s):  
Steven P LaRosa ◽  
Steven M. Opal
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Organ Dysfunction ◽  
Fluid Resuscitation ◽  
Multiorgan Failure ◽  
Sepsis Management ◽  
The Past ◽  
Sepsis And Septic Shock

Sepsis, along with the multiorgan failure that often accompanies this condition, is a leading cause of mortality in the intensive care unit. Although modest improvements in the prognosis have been made over the past two decades and promising new therapies continue to be investigated, innovations in the management of septic shock are still required. This chapter discusses the definitions, epidemiology, and pathogenesis (including microbial factors, host-derived mediators, and organ dysfunction) relating to sepsis. Management of severe sepsis and septic shock is also described.  This review contains 5 figures, 11 tables, and 99 references. Keywords:Organ dysfunction, sepsis, septic shock, infection, bacteremia, fluid resuscitation, vasopressor

TIME TO ANTIBIOTIC ADMINISTRATION AND OUTCOME IN SEVERE SEPSIS AND SEPTIC SHOCK

CHEST Journal ◽  
2007 ◽  
Vol 132 (4) ◽  
pp. 495A
Author(s):  
Henry Ostman ◽  
Vinay K. Sharma ◽  
Karim Djekidel ◽  
Alan Haber
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Antibiotic Administration ◽  
Sepsis And Septic Shock

195: An Automated Electronic Notification System as a Screening Tool for Severe Sepsis and Septic Shock

2010 ◽  
Vol 56 (3) ◽  
pp. S64-S65 ◽  
Author(s):  
R.J. Attwood ◽  
V.D. Smith ◽  
C.S. Russi ◽  
E.P. Hess ◽  
P. Escalante ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Screening Tool ◽  
Notification System ◽  
Sepsis And Septic Shock

Sepsis

2020 ◽  
Author(s):  
Steven P LaRosa ◽  
Steven M. Opal
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Organ Dysfunction ◽  
Fluid Resuscitation ◽  
Multiorgan Failure ◽  
Sepsis Management ◽  
The Past ◽  
Sepsis And Septic Shock

Sepsis, along with the multiorgan failure that often accompanies this condition, is a leading cause of mortality in the intensive care unit. Although modest improvements in the prognosis have been made over the past two decades and promising new therapies continue to be investigated, innovations in the management of septic shock are still required. This chapter discusses the definitions, epidemiology, and pathogenesis (including microbial factors, host-derived mediators, and organ dysfunction) relating to sepsis. Management of severe sepsis and septic shock is also described.  This review contains 5 figures, 11 tables, and 99 references. Keywords:Organ dysfunction, sepsis, septic shock, infection, bacteremia, fluid resuscitation, vasopressor

scholarly journals The Implementation of Sepsis Bundles on the Outcome of Patients with Severe Sepsis or Septic Shock in Intensive Care Units

2014 ◽  
Vol 8 (2) ◽  
pp. 60-65 ◽  
Author(s):  
Shu-Lien Chou ◽  
Khee-Siang Chan ◽  
Kuo-Chen Cheng ◽  
Willy Chou ◽  
Hui-Mei Hung ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Sepsis Bundles

A multifaceted educational intervention shortened time to antibiotic administration in children with severe sepsis and septic shock: ABISS Edusepsis pediatric study

2017 ◽  
Vol 43 (12) ◽  
pp. 1916-1918 ◽  
Author(s):  
Elisabeth Esteban ◽  
Sylvia Belda ◽  
Patricia García-Soler ◽  
Antonio Rodríguez-Núñez ◽  
Cristina Calvo ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Educational Intervention ◽  
Antibiotic Administration ◽  
Pediatric Study ◽  
Sepsis And Septic Shock

scholarly journals Multifaceted interventions to decrease mortality in patients with severe sepsis/septic shock—a quality improvement project

PeerJ ◽  
2015 ◽  
Vol 3 ◽  
pp. e1290 ◽  
Author(s):  
Brittany Siontis ◽  
Jennifer Elmer ◽  
Richard Dannielson ◽  
Catherine Brown ◽  
John Park ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Statistical Significance ◽  
Educational Interventions ◽  
Improvement Project ◽  
Early Goal Directed Therapy ◽  
Improve Compliance ◽  
Multifaceted Interventions ◽  
Physician Order Entry ◽  
Order Set

Despite knowledge that EGDT improves outcomes in septic patients, staff education on EGDT and compliance with the CPOE order set has been variable. Based on results of a resident survey to identify barriers to decrease severe sepsis/septic shock mortality in the medical intensive care unit (MICU), multifaceted interventions such as educational interventions to improve awareness to the importance of early goal-directed therapy (EGDT), and the use of the Computerized Physician Order Entry (CPOE) order set, were implemented in July 2013. CPOE order set was established to improve compliance with the EGDT resuscitation bundle elements. Orders were reviewed and compared for patients admitted to the MICU with severe sepsis/septic shock in July and August 2013 (controls) and 2014 (following the intervention). Similarly, educational slide sets were used as interventions for residents before the start of their ICU rotations in July and August 2013. While CPOE order set compliance did not significantly improve (78% vs. 76%,p= 0.74), overall EGDT adherence improved from 43% to 68% (p= 0.0295). Although there was a trend toward improved mortality, this did not reach statistical significance. This study shows that education interventions can be used to increase awareness of severe sepsis/septic shock and improve overall EGDT adherence.

Epidemiology, recognition and documentation of sepsis in the pre-hospital setting and associated clinical outcomes: a prospective multicenter study

2016 ◽  
Vol 15 (4) ◽  
pp. 168-175
Author(s):  
Nadia Alam ◽  
◽  
Kirtiedevi BNS Doerga ◽  
Tahira Hussain ◽  
Sadia Hussain ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Setting ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Antibiotic Administration ◽  
Care Chain ◽  
Discharge Letter ◽  
Study Population ◽  
Sepsis And Septic Shock

Introduction: General practitioners (GPs) and the emergency medical services (EMS) personnel have a pivotal role as points of entry into the acute care chain. This study was conducted to investigate the recognition of sepsis by GPs and EMS personnel and to evaluate the associations between recognition of sepsis in the pre-hospital setting and patient outcomes. Methods Design: prospective, observational study during a 12 week period in the emergency department (ED) of two academic hospitals. Study population: Patients >18 years presenting with sepsis at the ED. The information available in the ED discharge letter and the ED charts was used to make a definite diagnosis of sepsis, severe sepsis and septic shock Outcome measures: primary: recognition/documentation of sepsis. Secondary: ED arrival time to antibiotic administration, in-hospital mortality, hospital length of stay (LOS) and intensive care unit (ICU) admission. Results: A total of 301 patients were included in the study. GPs and EMS personnel correctly identified and documented 31.6% (n=114) and 41.4% of all sepsis patients (n=140) respectively. Recognition and documentation of sepsis improved with increasing severity. The mean time to administration of antibiotics (TTA) was nearly halved for the group of patients where sepsis was documented (GP: 66,4 minutes, EMS: 65,6 minutes) compared to the group in which sepsis was not documented (GP: 123,9 minutes, EMS: 101,5 minutes; p= 0.365 and p= 0.024 respectively). Conclusions: There is room for improvement in the recognition of sepsis, severe sepsis and septic shock by practitioners working in the pre-hospital setting. Documentation of sepsis prior to arrival in hospital led to a reduced time delay in administration of antibiotics.

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