T Jagneaux, A Grantham, K Richard, C Thomas, C D’Antonio, M Laperouse, R Scoggins, H O’Neal
{"title":"B-200 为急诊室就诊的可能感染患者提供新型诊断方法,加快隐匿性败血症的鉴定速度","authors":"T Jagneaux, A Grantham, K Richard, C Thomas, C D’Antonio, M Laperouse, R Scoggins, H O’Neal","doi":"10.1093/clinchem/hvae106.560","DOIUrl":null,"url":null,"abstract":"Background In August 2023 Our Lady of the Lake Regional Medical Center implemented a process for sepsis care based on a novel sepsis diagnostic (IntelliSep) in the Emergency Department (ED). As a component of our Sepsis Learning Health Program, we continually evaluate this process. Methods A nurse-driven protocol allows for IntelliSep ordering with triage assessment. Dependent upon bed availability and assessment for clinical stability by the triage staff, patients may be referred to the waiting room after blood draw. An IntelliSep Band 3 result is a critical value, initiating a sepsis pathway. Patients in waiting room at the time of a Band 3 result are immediately placed in an ED bed. We evaluated this process for efficacy and efficiency through review of the medical record. Results Between 01-Sep-2023 and 07-Feb-2024, we performed a total of 2322 IntelliSep tests, with 247 (10.6%) resulting prior to bed assignment, consisting of 124 (50.2%) Band 1, 73 (29.6%) Band 2, and 50 (20.2%) Band 3. The median time to bed assignment (TTB) for these patients was 104 min (Q1-Q3 71-180). TTB for Band 3 (median 73 min, Q1-Q3 58-102) was significantly lower than both Band 1 (146 min, Q1-Q3 86-201 min) and Band 2 (98 min, Q1-Q3 70-174 min), p < 0.0001 and 0.01 respectively. Providers admitted 45 (90%) of Band 3 patients and 62 (50%) of Band 1 patients (p < 0.0001). Discharge diagnosis included infection in 47 (94%) and sepsis in 27 (54%) of Band 3 patients, and infection in 686 (54.8%) and sepsis in 2 (1.6%) of Band 1 patients (p < 0.0001 for infection and sepsis). Conclusions An IntelliSep-based process for sepsis diagnosis, implemented at triage, can expedite identification and treatment of patients presenting to the ED with occult sepsis who appear clinically stable by triage staff.","PeriodicalId":10690,"journal":{"name":"Clinical chemistry","volume":null,"pages":null},"PeriodicalIF":7.1000,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"B-200 Expediting Identification of Occult Sepsis with a Novel Diagnostic for Patients Presenting to the ED with Possible Infection\",\"authors\":\"T Jagneaux, A Grantham, K Richard, C Thomas, C D’Antonio, M Laperouse, R Scoggins, H O’Neal\",\"doi\":\"10.1093/clinchem/hvae106.560\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background In August 2023 Our Lady of the Lake Regional Medical Center implemented a process for sepsis care based on a novel sepsis diagnostic (IntelliSep) in the Emergency Department (ED). As a component of our Sepsis Learning Health Program, we continually evaluate this process. Methods A nurse-driven protocol allows for IntelliSep ordering with triage assessment. Dependent upon bed availability and assessment for clinical stability by the triage staff, patients may be referred to the waiting room after blood draw. An IntelliSep Band 3 result is a critical value, initiating a sepsis pathway. Patients in waiting room at the time of a Band 3 result are immediately placed in an ED bed. We evaluated this process for efficacy and efficiency through review of the medical record. Results Between 01-Sep-2023 and 07-Feb-2024, we performed a total of 2322 IntelliSep tests, with 247 (10.6%) resulting prior to bed assignment, consisting of 124 (50.2%) Band 1, 73 (29.6%) Band 2, and 50 (20.2%) Band 3. The median time to bed assignment (TTB) for these patients was 104 min (Q1-Q3 71-180). TTB for Band 3 (median 73 min, Q1-Q3 58-102) was significantly lower than both Band 1 (146 min, Q1-Q3 86-201 min) and Band 2 (98 min, Q1-Q3 70-174 min), p < 0.0001 and 0.01 respectively. Providers admitted 45 (90%) of Band 3 patients and 62 (50%) of Band 1 patients (p < 0.0001). Discharge diagnosis included infection in 47 (94%) and sepsis in 27 (54%) of Band 3 patients, and infection in 686 (54.8%) and sepsis in 2 (1.6%) of Band 1 patients (p < 0.0001 for infection and sepsis). Conclusions An IntelliSep-based process for sepsis diagnosis, implemented at triage, can expedite identification and treatment of patients presenting to the ED with occult sepsis who appear clinically stable by triage staff.\",\"PeriodicalId\":10690,\"journal\":{\"name\":\"Clinical chemistry\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":7.1000,\"publicationDate\":\"2024-10-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical chemistry\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/clinchem/hvae106.560\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICAL LABORATORY TECHNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical chemistry","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/clinchem/hvae106.560","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICAL LABORATORY TECHNOLOGY","Score":null,"Total":0}
B-200 Expediting Identification of Occult Sepsis with a Novel Diagnostic for Patients Presenting to the ED with Possible Infection
Background In August 2023 Our Lady of the Lake Regional Medical Center implemented a process for sepsis care based on a novel sepsis diagnostic (IntelliSep) in the Emergency Department (ED). As a component of our Sepsis Learning Health Program, we continually evaluate this process. Methods A nurse-driven protocol allows for IntelliSep ordering with triage assessment. Dependent upon bed availability and assessment for clinical stability by the triage staff, patients may be referred to the waiting room after blood draw. An IntelliSep Band 3 result is a critical value, initiating a sepsis pathway. Patients in waiting room at the time of a Band 3 result are immediately placed in an ED bed. We evaluated this process for efficacy and efficiency through review of the medical record. Results Between 01-Sep-2023 and 07-Feb-2024, we performed a total of 2322 IntelliSep tests, with 247 (10.6%) resulting prior to bed assignment, consisting of 124 (50.2%) Band 1, 73 (29.6%) Band 2, and 50 (20.2%) Band 3. The median time to bed assignment (TTB) for these patients was 104 min (Q1-Q3 71-180). TTB for Band 3 (median 73 min, Q1-Q3 58-102) was significantly lower than both Band 1 (146 min, Q1-Q3 86-201 min) and Band 2 (98 min, Q1-Q3 70-174 min), p < 0.0001 and 0.01 respectively. Providers admitted 45 (90%) of Band 3 patients and 62 (50%) of Band 1 patients (p < 0.0001). Discharge diagnosis included infection in 47 (94%) and sepsis in 27 (54%) of Band 3 patients, and infection in 686 (54.8%) and sepsis in 2 (1.6%) of Band 1 patients (p < 0.0001 for infection and sepsis). Conclusions An IntelliSep-based process for sepsis diagnosis, implemented at triage, can expedite identification and treatment of patients presenting to the ED with occult sepsis who appear clinically stable by triage staff.
期刊介绍:
Clinical Chemistry is a peer-reviewed scientific journal that is the premier publication for the science and practice of clinical laboratory medicine. It was established in 1955 and is associated with the Association for Diagnostics & Laboratory Medicine (ADLM).
The journal focuses on laboratory diagnosis and management of patients, and has expanded to include other clinical laboratory disciplines such as genomics, hematology, microbiology, and toxicology. It also publishes articles relevant to clinical specialties including cardiology, endocrinology, gastroenterology, genetics, immunology, infectious diseases, maternal-fetal medicine, neurology, nutrition, oncology, and pediatrics.
In addition to original research, editorials, and reviews, Clinical Chemistry features recurring sections such as clinical case studies, perspectives, podcasts, and Q&A articles. It has the highest impact factor among journals of clinical chemistry, laboratory medicine, pathology, analytical chemistry, transfusion medicine, and clinical microbiology.
The journal is indexed in databases such as MEDLINE and Web of Science.