脓毒症干预方案(SIP)对急诊科3小时和6小时捆绑治疗依从性和死亡率结果的影响

Osagie Igiebor, Mohamed Nakeshbandi, Ninfa Mehta, Randi Ozaki, Michael Lucchesi, Maryanne Daley, Moro O Salifu, Samy I McFarlane
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引用次数: 4

摘要

脓毒症是一种常见的诊断,每年影响美国近170万成年人。根据疾病控制中心(CDC)的数据,每年有超过27万美国人死于败血症,三分之一的医院死亡病例归因于败血症。2004年出版的《脓毒症生存运动(SSC)严重脓毒症和脓毒症休克管理指南》提供了脓毒症治疗的关键要素,分为两类护理,即“复苏”和“管理”,包括在规定时间内完成的干预措施。在这项质量改进研究中,我们实施了一项脓毒症干预方案(SIP),旨在提高3小时和6小时治疗包的依从性,并研究对急诊科出现严重脓毒症和脓毒性休克患者死亡率的影响。我们分析了2017年第二季度至2018年第二季度(2017年4月至2018年6月),即实施SIP之前,急诊科向纽约州卫生部(NYSDOH)报告的数据,并与实施SIP后的2018Q3至2019Q2(2018年7月至2019年6月)的数据进行了比较。SIP的实施增加了3小时和6小时捆绑治疗的依从性,并显示出临床显着降低了干预前平均医院死亡率40.3%到干预后平均医院死亡率28.7%。对干预前和干预后平均住院死亡率的t检验分析显示,死亡率结果的降低也具有统计学意义(p
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Impact of Sepsis Intervention Protocol (SIP) on Adherence to Three-hour and Six-hour Bundles and Mortality Outcomes in the Emergency Department.

Sepsis is a commonly encountered diagnosis affecting nearly 1.7 million adults in the USA annually. According to Center for Disease Control (CDC), over 270,000 Americans die of sepsis each year and 1 in 3 hospital mortalities is attributed to sepsis. The Surviving Sepsis Campaign (SSC) Guidelines for management of severe sepsis and septic shock published in 2004 provide key elements in the treatment of sepsis that are organized into two bundles of care, the "resuscitation" and "management" bundles, including interventions to be accomplished within specified timeframes. In this quality improvement study, we implemented a sepsis intervention protocol (SIP) intended to increase adherence to 3-hour and 6-hour bundles, and to examine the impact on mortality of patients presenting with severe sepsis and septic shock in our emergency department. We analyzed data from our emergency department as reported to the New York State Department of Health (NYSDOH) from 2017Q2 to 2018Q2 (April 2017 -June 2018), the period prior to implementation of SIP, compared to data from 2018Q3 to 2019Q2 (July 2018 to June 2019) after implementation of SIP. The implementation of SIP resulted in increased3-hour and 6-hour bundle adherence and showed a clinically significant reduction of the mean pre-intervention hospital percent mortality of 40.3% to a mean post-intervention hospital percent mortality of 28.7%. A t-test analysis of the pre and post intervention mean hospital percent mortality revealed a reduction in mortality outcomes that was also statistically significant (p <0.05). Our study demonstrates that a well-designed and implemented SIP can increase bundle adherence and is highly effective in reducing mortality among high-risk population.

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