Prehospital sepsis alert notification decreases time to initiation of CMS sepsis core measures

Hunter, Christopher L.; Silvestri, Salvatore; Stone, Amanda M.; Shaughnessy, Anne; Miller, Stacie; Rodriguez, Alexa; Papa, Linda

doi:10.1016/j.ajem.2018.09.034

Cited by 26 publications

(19 citation statements)

References 23 publications

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“…Many studies have found that training in recognition of sepsis by the EMS personnel reduces the time that elapses from arrival at the emergency department to first administration of antibiotics 10,12,29‐32 . One study found that patients with bacterial meningitis diagnosed upon arrival had a median time to antibiotic therapy of 1.3 hours compared to 8.5 hours when diagnosed after arrival 31 .…”

Section: Discussionmentioning

confidence: 99%

Pre‐hospital antibiotic therapy preceded by blood cultures in a physician‐manned mobile emergency care unit

Mikkelsen

Gregers²,

Justesen

et al. 2021

Acta Anaesthesiol Scand

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Background Rapid recognition and antibiotic treatment, preferably preceded by blood cultures (BCs), is a mainstay in sepsis therapy. The objective of this investigation was to determine if pre‐hospital BCs were feasible and drawn with an acceptably low level of contamination and to investigate whether pre‐hospital antibiotics were administered on correct indications. Methods We performed a register‐based study in a pre‐hospital physician‐manned mobile emergency care unit (MECU) operating in a mixed urban/rural area in Denmark. All patients who received pre‐hospital antibiotics by the MECU from November 2013 to October 2018 were reviewed. Outcome measures were characterisation of microbial findings and subsequent in‐hospital confirmation of the pre‐hospital indication for antibiotics. Results One‐hundred‐and‐nineteen patients received antibiotics pre‐hospitally. Six were excluded. One‐hundred‐and‐thirteen patients were included in the study. BCs were drawn in 107 of the 113 patients (94.7% [88.8%‐98.0%]). We found a true pathogen of sepsis in 29 (27.1% [19.0%‐36.6%]) of these 107 patients. Nine (8.4% [3.9%‐15.4%]) patients had contaminated pre‐hospital BCs. Forty‐nine of all patients (36.3% [27.4%‐45.9%]) had causative pathogens in either their BCs or other samples confirming the pre‐hospital tentative diagnosis. Eighty‐two (72.6% [63.4%‐80.5%]) patients received antibiotic therapy in‐hospitally, while 27 (23.9% [16.4%‐32.8%]) were assigned an in‐hospital diagnosis not associated with infection. Four (3.5% [1.0%‐8.8%]) patients died in hospital before a diagnosis was established. Conclusions Pre‐hospital administration of antibiotics preceded by BCs is feasible, although with somewhat high blood culture contamination rates. Antibiotics are administered on reasonable indications.

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Section: Discussionmentioning

confidence: 99%

Pre‐hospital antibiotic therapy preceded by blood cultures in a physician‐manned mobile emergency care unit

Mikkelsen

Gregers²,

Justesen

et al. 2021

Acta Anaesthesiol Scand

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“…This is important since documentation of sepsis by EMS could be further improved, whereas patients who are recognized receive appropriate care sooner when they subsequently arrive in the ED. [3,4,17–19]…”

Section: Discussionmentioning

confidence: 99%

Characteristics of the prehospital phase of adult emergency department patients with an infection: A prospective pilot study

et al. 2019

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ObjectiveResearch on serious infections/sepsis has focused on the hospital environment, while potentially the most delay, and therefore possibly the best opportunity to improve quality of care, lies in the prehospital setting. In this study we investigated the prehospital phase of adult emergency department (ED) patients with an infection.MethodsIn this prospective pilot study all adult (≥18y) patients with a suspected/proven infection, based on the notes in the patient’s ED chart, were included during a 4-week period in 2017. Prehospital course, ED findings, presence of sepsis and 30-day outcomes were registered.ResultsA total of 440 patients were identified, with a median symptom duration before ED visit of 3 days (IQR 1–7 days). Before arrival in the ED, 23.9% of patients had used antibiotics. Most patients (83.0%) had been referred by a general practitioner (GP), while 41.1% of patients had visited their GP previously during the current disease episode. Patients referred by a GP were triaged as high-urgency less often, while vital parameters were similar. Emergency Medical Services (EMS) transported 268 (60.9%) of patients. Twenty-two patients (5.0%) experienced an adverse outcome (30-day all-cause mortality and/or admission to intensive care).ConclusionsPatients with a suspected infection had symptoms for 3 (IQR 1–7) days at the moment of presentation to the ED. During this prehospital phase patients often had consulted, and were treated by, their GP. Many were transported to the ED by EMS. Future research on severe infections should focus on the prehospital phase, targeting patients and primary care professionals.

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“…Studies have demonstrated a BPA leading to decreased time to antibiotics and other parameters [14][15], nevertheless, it did not lead to an improvement in mortality [14][15]. Personnel driven models, either with a sepsis response team or triage protocol, have also had varying degrees of success with decreasing time to sepsis bundle parameters [7][8][9][10][11], with only one demonstrating a possible mortality benefit [16]. Overall, similar to our study, the vast majority of these interventions have led to some improvement in achieving different sepsis core measurements [7][8][9][10][11][13][14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

“…Achieving the initial sepsis core-bundle within three hours can be challenging, and sepsis may not always be obvious based on the initial presentation. For this reason, a variety of approaches have been developed to maximize adherence to the sepsis core measures [7][8][9][10][11]. One method that could conceivably improve sepsis bundle achievement is having additional staff specifically designed to help with the resuscitation of patients that are critically ill. At our institution, we have developed a novel one-month rotation dedicated to resuscitative care in the ED [12].…”

Section: Introductionmentioning

confidence: 99%

Resuscitation Resident Impact in the Treatment of Sepsis

Burla

Shinthia

Boura

et al. 2020

Cureus

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Prehospital sepsis alert notification decreases time to initiation of CMS sepsis core measures

Cited by 26 publications

References 23 publications

Pre‐hospital antibiotic therapy preceded by blood cultures in a physician‐manned mobile emergency care unit

Pre‐hospital antibiotic therapy preceded by blood cultures in a physician‐manned mobile emergency care unit

Characteristics of the prehospital phase of adult emergency department patients with an infection: A prospective pilot study

Resuscitation Resident Impact in the Treatment of Sepsis

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