Early Detection and Treatment of Severe Sepsis in the Emergency Department: Identifying Barriers to Implementation of a Protocol-based Approach

Burney, Mara; Underwood, Joseph P.; McEvoy, Shayna; Nelson, Germaine; Dzierba, Amy; Kauari, Vepuka; Chong, David H.

doi:10.1016/j.jen.2011.08.011

Cited by 52 publications

(40 citation statements)

References 17 publications

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“…We found statistical significant differences in the overall 3 and 6 hours bundle compliance for severe sepsis in ED vs. inpatient but no statistical significant difference was noted in overall 3 and 6 hours bundle compliance for septic shock. As indicated in the survey, common barriers in the inpatient arm included delaying in identifying septic patients and knowledge deficit, which are similar to barriers reported in the previous studies [14][15][16]. An important consideration in interpreting these results is that bundle compliance is defined as "all-or-none".…”

Section: Discussionsupporting

confidence: 66%

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The Impact of the Location of Sepsis Presentation on Compliance to Centers for Medicare and Medicaid Services (CMS) Sepsis Core Measures: A Retrospective Cohort study

Amer¹

2018

ETS

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Objectives: In 2015, the Centers for Medicare and Medicaid Services implemented Severe Sepsis (SS) and Septic Shock (SSh) core measures. This study compared compliance to the measures between Emergency Department (ED) and Inpatients (IP). Secondary objectives included compliance to each bundle component, risk factors for noncompliance, hospital and ICU Length Of Stay (LOS), 30-day mortality, and antibiotic initiation within one hour of presentation. Methods:A retrospective, single-center and cohort study. Included patients with admission ICD code of SS and SSh between January 1 -June 30, 2016. Patients were excluded if they were less than 18 years of age, admitted with other types of shock (including cardiogenic shock, hemorrhagic shock and anaphylactoid reaction), pregnancy, expired within 6 hours of presentation, admitted to a hospice or palliative care/withdrawal of care before full therapy could be conducted, and transferred from another facility including transferred Results: 272 encounters were screened; 118 were excluded. The 154 remaining subjects were distributed in a 2:1 ratio between ED and IP (ICUs and other hospital floors). For SS, overall 3-hour bundle compliance was 60.6% in ED vs. 34 % in IP (P = 0.003); and overall 6-hour bundle compliance was 51% in ED vs. 25 % in IP (P = 0.046). There were no differences in 3 or 6-hour bundle compliance for SSh. Comparing individual components, only the initial and repeated lactate rates were different: ED -78.8% vs. IP -46%; p < 0.001, and ED -51% vs. IP -25%; p= 0.046, respectively. Hospital and ICU LOS was shorter in the ED arm. Antibiotic initiation in one hour occurred more often in the IP arm (56% vs. 10.6%; P = 0.001). 30-day mortality was not different. Marwa Conclusion:In this study, core measure compliance is higher when sepsis presents in the ED. Utilizing such data will guide targeted efforts for sepsis bundles compliance.

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Section: Discussionsupporting

confidence: 66%

“…In previous studies, 20% compliance rate was considered appropriate [14,15]. Assuming this compliance rate, a relative difference of 30% between the two treatment groups with 80% power and 5% α would require at least 150 total subjects after accounting for the 2:1 ED/IP allocation.…”

Section: Discussionmentioning

confidence: 99%

The Impact of the Location of Sepsis Presentation on Compliance to Centers for Medicare and Medicaid Services (CMS) Sepsis Core Measures: A Retrospective Cohort study

Amer¹

2018

ETS

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“…Emergency department-based sepsis resuscitation, however, is complex and difficult for many reasons, and studies have demonstrated a lack of protocol adherence [36][37][38]. Much of this is due to issues related to nurse staffing and physician skills regarding SCVO 2 and CVP monitoring [39][40][41][42].…”

Section: Discussionmentioning

confidence: 99%

End-tidal carbon dioxide as a goal of early sepsis therapy

Guirgis

Williams

Kalynych

et al. 2014

The American Journal of Emergency Medicine

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“…In the United States, sepsis is in the top ten leading causes of death, with a mortality rate between forty to sixty percent (Burney et al, 2012). With over half a million annual ED visits for sepsis, the aforementioned mortality rate must be decreased.…”

mentioning

confidence: 99%

Early Recognition of Sepsis in the Emergency Department

2018

ARC Journal of Nursing and Healthcare

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Early Detection and Treatment of Severe Sepsis in the Emergency Department: Identifying Barriers to Implementation of a Protocol-based Approach

Cited by 52 publications

References 17 publications

The Impact of the Location of Sepsis Presentation on Compliance to Centers for Medicare and Medicaid Services (CMS) Sepsis Core Measures: A Retrospective Cohort study

The Impact of the Location of Sepsis Presentation on Compliance to Centers for Medicare and Medicaid Services (CMS) Sepsis Core Measures: A Retrospective Cohort study

End-tidal carbon dioxide as a goal of early sepsis therapy

Early Recognition of Sepsis in the Emergency Department

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