Screening for sepsis in general hospitalized patients: a systematic review

Alberto, Laura; Marshall, Andrea P.; Walker, Rachel; Aitken, Leanne M.

doi:10.1016/j.jhin.2017.05.005

Cited by 43 publications

(32 citation statements)

References 39 publications

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“… 13 The studies that found no effect on ICU LOS varied in setting, with 1 implemented in the ED, 1 in a medical ICU, and 1 in all noncritical care units. 21 One study attributed lack of impact on ICU LOS to a PMS with poor predictive value, 9 and one credited the already vigilant ICU staff 12 ; the third was underpowered to detect modest changes in ICU LOS. Two studies reported on ICU transfer rate, and neither found a significant effect on this or any other outcome measure.…”

Section: Resultsmentioning

confidence: 99%

“… 9 , 11 , 13 , 17 , 22 , 23 In addition, 4 systematic reviews covered this topic to some degree. 21 , 24 – 26 The most commonly reported process measure was time to antibiotic administration (n = 8), followed by time to lactate measurement and blood culture draw (n = 5 each), and time to fluid administration (n = 3).…”

Section: Resultsmentioning

confidence: 99%

“…Three other systematic reviews found mixed results on improvement in sepsis process measures (including time to antibiotic administration among others mentioned previously). 21 , 25 , 26 Despins 25 searched for automated sepsis detection in the hospital setting (ICUs, EDs, and general wards) from 2005 to 2015; Makam and colleagues 26 searched for electronic sepsis recognition systems in ICUs, EDs, and general wards through June 2014; and Alberto and colleagues 21 searched for sepsis screening systems in only general hospital wards through June 2016. Several studies these authors reviewed (all observational and all outside the ICU) reported that PMSs significantly improved time to administration of antibiotics, lactate draw, blood culture draw, and/or fluid administration.…”

Section: Resultsmentioning

confidence: 99%

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The Use of Patient Monitoring Systems to Improve Sepsis Recognition and Outcomes: A Systematic Review

Gale

Hall²

2020

J Patient Saf

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Introduction The aim of this systematic review was to determine the impact of automated patient monitoring systems (PMSs) on sepsis recognition and outcomes. Methods Systematic searches were conducted using CINAHL, MEDLINE, and Cochrane, for articles published from 2008 through 2018. English-language, peer-reviewed articles that reported the impact of PMS on sepsis care were included. For selected articles, the authors abstracted information, with the study designed to be compliant with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Results Nineteen articles were identified for inclusion: 4 systematic reviews and 15 individual studies. Study design and quality varied, with some randomized controlled trials and quasiexperimental studies, as well as many observational studies. Study results for outcome measures (e.g., mortality, intensive care unit [ICU] length of stay, ICU transfer) were mixed, with more than half of the studies showing a significant improvement in at least one measure. Evidence for process measure (e.g., time to antibiotic administration, lactate measurement, etc.) improvement was of moderate strength across multiple types of hospital units, and evidence was most consistent outside the ICU. Conclusions Automated sepsis PMSs have the potential to improve sepsis recognition and outcomes, but current evidence is mixed on their effectiveness. More high-quality studies are needed to understand the effects of PMSs on important sepsis-related process and outcome measures in different hospital units.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The Use of Patient Monitoring Systems to Improve Sepsis Recognition and Outcomes: A Systematic Review

Gale

Hall²

2020

J Patient Saf

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“…(45) Other studies have demonstrated high sensitivity and specificity in the detection of sepsis with the use of screening tools, both electronic and manual, but more studies are needed to determine the effectiveness of each type of alert. (46-50) Despite this, there were no difficulties in the implementation or overload of the work of the medical or nursing staff.…”

Section: Discussionmentioning

confidence: 99%

An electronic warning system helps reduce the time to diagnosis of sepsis

Westphal¹,

Pereira²,

Fachin³

et al. 2018

Revista Brasileira De Terapia Intensiva

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ObjectiveTo describe the improvements of an early warning system for the identification of septic patients on the time to diagnosis, antibiotic delivery, and mortality.MethodsThis was an observational cohort study that describes the successive improvements made over a period of 10 years using an early warning system to detect sepsis, including systematic active manual surveillance, electronic alerts via a telephonist, and alerts sent directly to the mobile devices of nurses. For all periods, after an alert was triggered, early treatment was instituted according to the institutional sepsis guidelines.ResultsIn total, 637 patients with sepsis were detected over the study period. The median triage-to-diagnosis time was reduced from 19:20 (9:10 - 38:15) hours to 12:40 (2:50 - 23:45) hours when the manual surveillance method was used (p = 0.14), to 2:10 (1:25 - 2:20) hours when the alert was sent automatically to the hospital telephone service (p = 0.014), and to 1:00 (0:30 - 1:10) hour when the alert was sent directly to the nurse's mobile phone (p = 0.016). The diagnosis-to-antibiotic time was reduced to 1:00 (0:55 - 1:30) hours when the alert was sent to the telephonist and to 0:45 (0:30 - 1:00) minutes when the alert was sent directly to the nurse's mobile phone (p = 0.02), with the maintenance of similar values over the following years. There was no difference in the time of treatment between survivors and non-survivors.ConclusionElectronic systems help reduce the triage-to-diagnosis time and diagnosis-to-antibiotic time in patients with sepsis.

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“…(144) Negli ultimi anni si è notato un aumento della presa in carico dei pazienti con sepsi all'interno dei reparti medici e chirurgici e, in diversi paesi del Nord America e dell'Europa, è segnalato che il 14-80% dei pazienti ricoverati in tali reparti sviluppa sepsi. (148) Come per l'infarto miocardico acuto, lo stroke e il politrauma, anche per la sepsi sono stati riscontrati outcomes migliori quando è presente l'identificazione precoce e una gestione appropriata del quadro settico nelle ore iniziali,(145) e l'infermiere svolge un ruolo centrale ed attivo durante tutto il percorso di cura. Trattandosi di una sindrome difficile da diagnosticare l'identificazione precoce è fondamentale per la corretta gestione del quadro settico; affinché ciò avvenga è necessario che l'infermiere abbia competenze avanzate non solo per la valutazione delle condizioni cliniche, che può avvenire anche attraverso l'uso discale di valutazione, ma soprattutto per la valutazione del rischio di sviluppare la sepsi.…”

Section: La Sepsiunclassified

Nursing clinical competence in area medica

2018

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Introduzione Background La nursing clinical competence Il concetto di clinical competence in medicina interna Declinare e classificare i livelli di competenza Aree di assistenza nei contesti di area medica Il paziente cronico Scompenso cardiaco La broncopneumopatia cronica e ostruttiva La cirrosi epatica La pancreatite Il diabete mellito Il delirium La depressione Il paziente critico L’ipertensione La trombosi venosa profonda L’ischemia cerebrale La disfagia Gli squilibri idroelettrolitici Le polmoniti I sanguinamenti gastro-intestinali La sepsi Il monitoraggio cardiaco La ventilazione non-invasiva L’ecografia operativa bedside Somministrazione di terapia e chemioterapia Le lesioni da pressione Il dolore Gli accessi vascolari Il paziente fragile La dimissione difficile Il fine vita Obiettivo Metodi Risultati Conclusioni Bibliografia

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Screening for sepsis in general hospitalized patients: a systematic review

Abstract: Clinicians, researchers and health decision-makers should consider these findings and limitations when implementing screening tools, research or policy on sepsis recognition in general hospitalized patients.

Cited by 43 publications

References 39 publications

The Use of Patient Monitoring Systems to Improve Sepsis Recognition and Outcomes: A Systematic Review

The Use of Patient Monitoring Systems to Improve Sepsis Recognition and Outcomes: A Systematic Review

An electronic warning system helps reduce the time to diagnosis of sepsis

Nursing clinical competence in area medica

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