Interhospital sepsis code in Catalonia (Spain): territorial model for initial care of patients with sepsis

Yébenes, Juan Carlos; Lorencio, C.; Esteban, Elisabeth; Espinosa, Laura A.; Badia, Josep M.; Capdevila, J.A.; Cisteró, Berta; Moreno, Susana Elisa; Calbo, Esther; Jiménez-Fàbrega, Xavier; Clèries, Montserrat; Faixedas, María Teresa; Ferrer, Ricard; Vela, Emili; Bravo, Carlos; Rodríguez, Alejandro; Netto, Chaves; Armero, Eva; Solsona, Manel; Lopez, Rosalba; Granes, Adrià Ferret; Perez-Claveria, V; Artigas, A.; Estany, J.

doi:10.1016/j.medine.2019.09.001

Cited by 9 publications

(11 citation statements)

References 32 publications

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“…El CS se ha ido instaurando estos últimos años de forma progresiva con diferentes iniciativas que han permitido el desarrollo de distintos protocolos, lo que ha podido ayudar a su implantación en los SUH [ 13 - 15 ]. Se ha descrito alguna estimación que fijaba la implantación del CS entre los SUH españoles en alrededor del 30-50% [ 4 ].…”

Section: Discussionunclassified

“…De forma paralela a esta baja informatización de los sistemas, se observa el pequeño número de hospitales que recogen los datos de cumplimiento de las medidas básicas iniciales ante la sospecha de un paciente con sepsis, lo que impide en gran medida tener una monitorización de las actuaciones que se están llevando a cabo, algo básico para detectar áreas de mejora y reconocer aquellas que se muestren realmente eficaces en el manejo de los pacientes [14,15,20]. Uno de los puntos clave en la actuación en los pacientes con sepsis es el reconocimiento precoz en los servicios de urgencias y emergencias.…”

Section: Tabla 3 Comparación Del Manejo De La Sepsis En Función Del Tamaño Del Hospital (Cont)unclassified

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Current situation of sepsis care in Spanish emergency departments

Llopis-Roca¹,

López-Izquierdo²,

Miró³

et al. 2022

Rev Esp Quimioter

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Objective. To describe the approach to the patients with suspected sepsis in the Spanish emergency department hospitals (ED) and analyze whether there are differences according to the size of the hospital and the number of visits to the emergency room. Method. Structured survey of those responsible for the 282 public EDs that serve adults 24 hours a day, 365 days a year. It was asked about assistance and management in the emergency room in the care of patients with suspected sepsis. The results are compared according to hospital size (large ≥ 500 beds vs medium-small <500) and influx to the emergency room (discharge ≥ 200 visits / day vs medium-low <200). Results. A total of 250 Spanish EDs responded (89%). Sepsis protocols are available in 163 (65%) EDs median weekly sepsis treated ranged from 0-5 per week in 39 (71%) ED, 6-10 per week in 10 (18%), 11-15 per week in 4 (7%), and more than 15 activations per week in 3 centers (3.6%). The criteria used for sepsis diagnosis were the qSOFA/SOFA in 105 (63.6%) of the hospitals, SIRS in 6 (3.6%), while in 49 (29.7%) they used both criteria simultaneously. In 79 centers, the sepsis diagnosis was computerized, and in 56 there were tools to help decision-making. 48% (79 of 163) of the EDs had data on bundles compliance. In 61% (99 of 163) of EDs there was training in sepsis and in 56% (55 of 99) it was periodic. Considering the size of the hospital, large hospitals participated more frequently as recipients of patients with sepsis and had an infectious, sepsis and short-stay unit, a microbiologist and infectious disease specialist on duty. Conclusion. Most EDs have sepsis protocols, but there is room for improvement. The computerization and development of alerts for diagnosis and treatment still have a long way to go in EDs.

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Section: Discussionunclassified

Section: Tabla 3 Comparación Del Manejo De La Sepsis En Función Del Tamaño Del Hospital (Cont)unclassified

Current situation of sepsis care in Spanish emergency departments

Llopis-Roca¹,

López-Izquierdo²,

Miró³

et al. 2022

Rev Esp Quimioter

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“…Locally directed protocols that used standard criteria and outcomes enhanced multiprofessional involvement and coordination [13] and improved efficiencies and outcomes, establishing unified management criteria [32,33]. In contrast to assigning responsibility to individual groups of clinicians, team-based strategies facilitated process management across specialties, ensuring continuity of care, adequate coordination, and staff inclusion to achieve measurable endpoints [34].…”

Section: What Is the Optimal Model Of Delivering Sepsis Care?mentioning

confidence: 99%

The Surviving Sepsis Campaign: research priorities for the administration, epidemiology, scoring and identification of sepsis

Nunnally

Ferrer

Martin

et al. 2021

ICMx

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Objective To identify priorities for administrative, epidemiologic and diagnostic research in sepsis. Design As a follow-up to a previous consensus statement about sepsis research, members of the Surviving Sepsis Campaign Research Committee, representing the European Society of Intensive Care Medicine and the Society of Critical Care Medicine addressed six questions regarding care delivery, epidemiology, organ dysfunction, screening, identification of septic shock, and information that can predict outcomes in sepsis. Methods Six questions from the Scoring/Identification and Administration sections of the original Research Priorities publication were explored in greater detail to better examine the knowledge gaps and rationales for questions that were previously identified through a consensus process. Results The document provides a framework for priorities in research to address the following questions: (1) What is the optimal model of delivering sepsis care?; (2) What is the epidemiology of sepsis susceptibility and response to treatment?; (3) What information identifies organ dysfunction?; (4) How can we screen for sepsis in various settings?; (5) How do we identify septic shock?; and (6) What in-hospital clinical information is associated with important outcomes in patients with sepsis? Conclusions There is substantial knowledge of sepsis epidemiology and ways to identify and treat sepsis patients, but many gaps remain. Areas of uncertainty identified in this manuscript can help prioritize initiatives to improve an understanding of individual patient and demographic heterogeneity with sepsis and septic shock, biomarkers and accurate patient identification, organ dysfunction, and ways to improve sepsis care.

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“…Furthermore, no single biomarker has yet been identified to accurately diagnose sepsis and predict its severity, but a combination of several of them could prove advantageous 7 . In 2016, our institution implemented a Sepsis Code, which was designed as a government initiative 8 . It is a manual qualitative tool to increase awareness, promote early detection and facilitate initial care and interhospital coordination to treat septic patients in a homogeneous manner throughout Catalonia.…”

Section: Introductionmentioning

confidence: 99%

New multivariable prediction model PEdiatric SEpsis recognition and stratification (PESERS score) shows excellent discriminatory capacity

et al. 2022

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Aim To develop a quantitative predictive scoring model for the early recognition and assessment of paediatric sepsis. Methods Prospective observational study including emergency department and in‐hospital febrile patients under 18 years. Sepsis diagnose (Goldstein 2005 definitions) was the main outcome. Variables associated with the outcome were included in a multivariable analysis. Cut‐off points, odds ratio and coefficients for the variables kept after the multivariable analysis were identified. The score was obtained from the coefficients, The AUC was obtained from ROC‐analysis, and internal validation was performed using k‐fold cross‐validation. Results The analysis included 210 patients. 45 variables were evaluated and the bivariate analysis identified 24 variables associated with the outcome. After the multivariable regression, 11 variables were kept and the score was obtained. The model yielded an excellent AUC of 0.886 (95% CI 0.845–0.927), p < 0.001 for sepsis recognition. With a cut‐off value of 5 for the score, we obtained a sensitivity of 98%, specificity of 76.7%, positive predictive value of 87.9% and negative predictive value of 93.3%. Conclusion The proposed scoring model for paediatric sepsis showed adequate discriminatory capacity and sufficient accuracy, which is of great clinical significance in detecting sepsis early and predicting its severity. Nevertheless external validation is needed before clinical use.

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Interhospital sepsis code in Catalonia (Spain): territorial model for initial care of patients with sepsis

Cited by 9 publications

References 32 publications

Current situation of sepsis care in Spanish emergency departments

Current situation of sepsis care in Spanish emergency departments

The Surviving Sepsis Campaign: research priorities for the administration, epidemiology, scoring and identification of sepsis

New multivariable prediction model PEdiatric SEpsis recognition and stratification (PESERS score) shows excellent discriminatory capacity

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