Impact of the implementation of a Sepsis Code Program in medical patient management: a cohort study in an Internal Medicine ward

Abstract

Introduction. Sepsis is the main cause of death in hospitals and the implementation of diagnosis and treatment bundles has shown to improve its evolution. However, there is a lack of evidence about patients attended in conventional units. Methods. A 3-year retrospective cohort study was conducted. Patients hospitalized in Internal Medicine units with sepsis were included and assigned to two cohorts according to Sepsis Code (SC) activation (group A) or not (B). Baseline and evolution variables were collected. Results. A total of 653 patients were included. In 296 cases SC was activated. Mean age was 81.43 years, median Charlson comorbidity index (CCI) was 2 and 63.25% showed some functional disability. More bundles were completed in group A: blood cultures 95.2% vs 72.5% (p < 0.001), extended spectrum antibiotics 59.1% vs 41.4% (p < 0.001), fluid resuscitation 96.62% vs 80.95% (p < 0.001). Infection control at 72 hours was quite higher in group A (81.42% vs 55.18%, odds ratio 3.55 [2.48-5.09]). Antibiotic was optimized more frequently in group A (60.77% vs 47.03%, p 0.008). Mean in-hospital stay was 10.63 days (11.44 vs 8.53 days, p < 0.001). Complications during hospitalization appeared in 51.76% of patients, especially in group B (45.95% vs 56.58%, odds ratio 1.53 [1.12-2.09]). Hospital readmissions were higher in group A (40% vs 24.76%, p < 0.001). 28-day mortality was significantly lower in group A (20.95% vs 42.86%, odds ratio 0.33 [0.23-0.47]). Conclusions. Implementation of SC seems to be effective in improving short-term outcomes in IM patients, although therapy should be tailored in an individual basis.

Decrease in Mortality after the Implementation of a Hospital Model to Improve Performance in Sepsis Care: Princess Sepsis Code

“…In our study, we do not have data on sepsis mortality before the implementation of PSC, but we did discover a decrease in mortality since the beginning of the program, in figures similar to those reported by these authors, along with a good compliance with the items in the SSC measure packages. In addition, our working group published a study in 2022 comparing the mortality of patients admitted to the internal medicine ward in whom the PSC alert was activated or not, detecting a significantly higher mortality at 28 days in patients where the PSC alert was not activated compared to patients with PSC activation (43% vs. 21%) [16].…”

“…The type of program employed in our hospital was endorsed by different published studies that confirmed its effectiveness, in a global manner and regarding specific aspects, during these years, and it was also endorsed by multidisciplinary recommendations that supported its implementation in a hospital environment [14][15][16][17].…”

Medical Emergency Team call within 24 h of medical admission with a focus on sepsis: a retrospective review

“…Our results add evidence to support the implementation of a sepsis management guideline beyond the bounds of the ED through integration into medical admission and MET processes. 41,42 Results of this study suggest that this may improve patient outcomes and reduce hospital LOS. This study also adds to the literature highlighting the complexity of ALF and ward-based response to clinical deterioration and raising the need to further understand how medical staff currently respond to deteriorating hospital patients.…”

Beneficios de la implementación del código sepsis en pacientes con shock séptico en el área hospitalaria

“…Desde el 2016 se crea una definición de sepsis por el Consenso Internacional, el mismo que menciona que sepsis es un síndrome de características clínicas en el cual se genera una falla orgánica que a su vez altera el proceso de homeostasis debido a la respuesta desregular del huésped ante la presencia de una infección (7). Cuando en la sepsis se genera alteraciones metabólicas, celulares y circulatorias, se produce shock séptico, donde aumenta la incidencia de mortalidad (11).…”

“…https://doi.org/10.55204/trc.v3i1.e167 da de forma localizada en el foco de la lesión(11). En la mayor parte de los casos de sepsis, los microorganismos causantes de la infección son bacilos Gramnegativos o cocos Gram-positivos, frecuentemente en pacientes con sistema inmune comprometido o con enfermedades de carácter crónico y debilitante.…”