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Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED
Abstract Background Early identification of sepsis in the emergency department (ED), followed by adequate fluid hydration and appropriate antibiotics, improves patient outcomes. Objectives We sought to measure the impact of a sepsis workup and treatment protocol (SWAT) that included an electronic he...
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| Published in: | The American journal of emergency medicine 2016-01, Vol.34 (1), p.1-9 |
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| container_title | The American journal of emergency medicine |
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| creator | Hayden, Geoffrey E., MD Tuuri, Rachel E., MD Scott, Rachel, MD Losek, Joseph D., MD Blackshaw, Aaron M Schoenling, Andrew J Nietert, Paul J., PhD Hall, Greg A., MD |
| description | Abstract Background Early identification of sepsis in the emergency department (ED), followed by adequate fluid hydration and appropriate antibiotics, improves patient outcomes. Objectives We sought to measure the impact of a sepsis workup and treatment protocol (SWAT) that included an electronic health record (EHR)–based triage sepsis alert, direct communication, mobilization of resources, and standardized order sets. Methods We conducted a retrospective, quasiexperimental study of adult ED patients admitted with suspected sepsis, severe sepsis, or septic shock. We defined a preimplementation (pre-SWAT) group and a postimplementation (post-SWAT) group and further broke these down into SWAT A (septic shock) and SWAT B (sepsis with normal systolic blood pressure). We performed extensive data comparisons in the pre-SWAT and post-SWAT groups, including demographics, systemic inflammatory response syndrome criteria, time to intravenous fluids bolus, time to antibiotics, length-of-stay times, and mortality rates. Results There were 108 patients in the pre-SWAT group and 130 patients in the post-SWAT group. The mean time to bolus was 31 minutes less in the postimplementation group, 51 vs 82 minutes (95% confidence interval, 15-46; P value < .01). The mean time to antibiotics was 59 minutes less in the postimplementation group, 81 vs 139 minutes (95% confidence interval, 44-74; P value < .01). Segmented regression modeling did not identify secular trends in these outcomes. There was no significant difference in mortality rates. Conclusions An EHR-based triage sepsis alert and SWAT protocol led to a significant reduction in the time to intravenous fluids and time to antibiotics in ED patients admitted with suspected sepsis, severe sepsis, and septic shock. |
| doi_str_mv | 10.1016/j.ajem.2015.08.039 |
| format | article |
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Objectives We sought to measure the impact of a sepsis workup and treatment protocol (SWAT) that included an electronic health record (EHR)–based triage sepsis alert, direct communication, mobilization of resources, and standardized order sets. Methods We conducted a retrospective, quasiexperimental study of adult ED patients admitted with suspected sepsis, severe sepsis, or septic shock. We defined a preimplementation (pre-SWAT) group and a postimplementation (post-SWAT) group and further broke these down into SWAT A (septic shock) and SWAT B (sepsis with normal systolic blood pressure). We performed extensive data comparisons in the pre-SWAT and post-SWAT groups, including demographics, systemic inflammatory response syndrome criteria, time to intravenous fluids bolus, time to antibiotics, length-of-stay times, and mortality rates. Results There were 108 patients in the pre-SWAT group and 130 patients in the post-SWAT group. The mean time to bolus was 31 minutes less in the postimplementation group, 51 vs 82 minutes (95% confidence interval, 15-46; P value < .01). The mean time to antibiotics was 59 minutes less in the postimplementation group, 81 vs 139 minutes (95% confidence interval, 44-74; P value < .01). Segmented regression modeling did not identify secular trends in these outcomes. There was no significant difference in mortality rates. Conclusions An EHR-based triage sepsis alert and SWAT protocol led to a significant reduction in the time to intravenous fluids and time to antibiotics in ED patients admitted with suspected sepsis, severe sepsis, and septic shock.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2015.08.039</identifier><identifier>PMID: 26386734</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Bacterial infections ; Clinical outcomes ; Clinical Protocols ; Confidence intervals ; Electronic Health Records ; Emergency ; Emergency medical care ; Emergency Service, Hospital ; Female ; Fluid Therapy ; Fluids ; Heart rate ; Hospitals ; Humans ; Infections ; Male ; Medical records ; Middle Aged ; Mortality ; Paging systems ; Patients ; Retrospective Studies ; Sepsis ; Sepsis - diagnosis ; Sepsis - mortality ; Sepsis - therapy ; Time Factors ; Triage</subject><ispartof>The American journal of emergency medicine, 2016-01, Vol.34 (1), p.1-9</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-1cf016acedf0cdc7ee825e6744d8d2ac79a641c27cf47a66294b7cf9c18935eb3</citedby><cites>FETCH-LOGICAL-c483t-1cf016acedf0cdc7ee825e6744d8d2ac79a641c27cf47a66294b7cf9c18935eb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26386734$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hayden, Geoffrey E., MD</creatorcontrib><creatorcontrib>Tuuri, Rachel E., MD</creatorcontrib><creatorcontrib>Scott, Rachel, MD</creatorcontrib><creatorcontrib>Losek, Joseph D., MD</creatorcontrib><creatorcontrib>Blackshaw, Aaron M</creatorcontrib><creatorcontrib>Schoenling, Andrew J</creatorcontrib><creatorcontrib>Nietert, Paul J., PhD</creatorcontrib><creatorcontrib>Hall, Greg A., MD</creatorcontrib><title>Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>Abstract Background Early identification of sepsis in the emergency department (ED), followed by adequate fluid hydration and appropriate antibiotics, improves patient outcomes. Objectives We sought to measure the impact of a sepsis workup and treatment protocol (SWAT) that included an electronic health record (EHR)–based triage sepsis alert, direct communication, mobilization of resources, and standardized order sets. Methods We conducted a retrospective, quasiexperimental study of adult ED patients admitted with suspected sepsis, severe sepsis, or septic shock. We defined a preimplementation (pre-SWAT) group and a postimplementation (post-SWAT) group and further broke these down into SWAT A (septic shock) and SWAT B (sepsis with normal systolic blood pressure). We performed extensive data comparisons in the pre-SWAT and post-SWAT groups, including demographics, systemic inflammatory response syndrome criteria, time to intravenous fluids bolus, time to antibiotics, length-of-stay times, and mortality rates. Results There were 108 patients in the pre-SWAT group and 130 patients in the post-SWAT group. The mean time to bolus was 31 minutes less in the postimplementation group, 51 vs 82 minutes (95% confidence interval, 15-46; P value < .01). The mean time to antibiotics was 59 minutes less in the postimplementation group, 81 vs 139 minutes (95% confidence interval, 44-74; P value < .01). Segmented regression modeling did not identify secular trends in these outcomes. There was no significant difference in mortality rates. Conclusions An EHR-based triage sepsis alert and SWAT protocol led to a significant reduction in the time to intravenous fluids and time to antibiotics in ED patients admitted with suspected sepsis, severe sepsis, and septic shock.</description><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Bacterial infections</subject><subject>Clinical outcomes</subject><subject>Clinical Protocols</subject><subject>Confidence intervals</subject><subject>Electronic Health Records</subject><subject>Emergency</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital</subject><subject>Female</subject><subject>Fluid Therapy</subject><subject>Fluids</subject><subject>Heart rate</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infections</subject><subject>Male</subject><subject>Medical records</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Paging systems</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Sepsis</subject><subject>Sepsis - diagnosis</subject><subject>Sepsis - mortality</subject><subject>Sepsis - therapy</subject><subject>Time Factors</subject><subject>Triage</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNp9kc2L1TAUxYMoznP0H3AhATduWvOdFkSQcfyAAReO6C7kpbeamjbPJFXmvzf1zSjMwlUu4XcO95yL0GNKWkqoej61doK5ZYTKlnQt4f0dtKOSs6ajmt5FO6K5bJSW-gQ9yHkihFIhxX10whTvlOZihz5fJm-_As5wyD5jGyAVbJfh5uOQYokuBhziL0i4-BkyLhGPYfVD_kPapfi9j8W7jP2CyzfA568fonujDRkeXb-n6NOb88uzd83Fh7fvz15dNE50vDTUjTWJdTCMxA1OA3RMgtJCDN3ArNO9VYI6pt0otFWK9WJf597RrucS9vwUPTv61kV_rJCLmX12EIJdIK7ZUC2JEKyGrejTW-gU17TU7TaKC8kIV5ViR8qlmHOC0RySn226MpSYrXYzma12s9VuSGdq7VX05Np63c8w_JXc9FyBF0cAahc_PSSTnYel5vYJXDFD9P_3f3lL7oJfvLPhO1xB_pfDZGaI-bgdfrs7lYRoor_w31Z8qDQ</recordid><startdate>20160101</startdate><enddate>20160101</enddate><creator>Hayden, Geoffrey E., MD</creator><creator>Tuuri, Rachel E., MD</creator><creator>Scott, Rachel, MD</creator><creator>Losek, Joseph D., MD</creator><creator>Blackshaw, Aaron M</creator><creator>Schoenling, Andrew J</creator><creator>Nietert, Paul J., PhD</creator><creator>Hall, Greg A., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20160101</creationdate><title>Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED</title><author>Hayden, Geoffrey E., MD ; Tuuri, Rachel E., MD ; Scott, Rachel, MD ; Losek, Joseph D., MD ; Blackshaw, Aaron M ; Schoenling, Andrew J ; Nietert, Paul J., PhD ; Hall, Greg A., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c483t-1cf016acedf0cdc7ee825e6744d8d2ac79a641c27cf47a66294b7cf9c18935eb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics</topic><topic>Bacterial infections</topic><topic>Clinical outcomes</topic><topic>Clinical Protocols</topic><topic>Confidence intervals</topic><topic>Electronic Health Records</topic><topic>Emergency</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital</topic><topic>Female</topic><topic>Fluid Therapy</topic><topic>Fluids</topic><topic>Heart rate</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infections</topic><topic>Male</topic><topic>Medical records</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Paging systems</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Sepsis</topic><topic>Sepsis - diagnosis</topic><topic>Sepsis - mortality</topic><topic>Sepsis - therapy</topic><topic>Time Factors</topic><topic>Triage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hayden, Geoffrey E., MD</creatorcontrib><creatorcontrib>Tuuri, Rachel E., MD</creatorcontrib><creatorcontrib>Scott, Rachel, MD</creatorcontrib><creatorcontrib>Losek, Joseph D., MD</creatorcontrib><creatorcontrib>Blackshaw, Aaron M</creatorcontrib><creatorcontrib>Schoenling, Andrew J</creatorcontrib><creatorcontrib>Nietert, Paul J., PhD</creatorcontrib><creatorcontrib>Hall, Greg A., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hayden, Geoffrey E., MD</au><au>Tuuri, Rachel E., MD</au><au>Scott, Rachel, MD</au><au>Losek, Joseph D., MD</au><au>Blackshaw, Aaron M</au><au>Schoenling, Andrew J</au><au>Nietert, Paul J., PhD</au><au>Hall, Greg A., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED</atitle><jtitle>The American journal of emergency medicine</jtitle><addtitle>Am J Emerg Med</addtitle><date>2016-01-01</date><risdate>2016</risdate><volume>34</volume><issue>1</issue><spage>1</spage><epage>9</epage><pages>1-9</pages><issn>0735-6757</issn><eissn>1532-8171</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Abstract Background Early identification of sepsis in the emergency department (ED), followed by adequate fluid hydration and appropriate antibiotics, improves patient outcomes. Objectives We sought to measure the impact of a sepsis workup and treatment protocol (SWAT) that included an electronic health record (EHR)–based triage sepsis alert, direct communication, mobilization of resources, and standardized order sets. Methods We conducted a retrospective, quasiexperimental study of adult ED patients admitted with suspected sepsis, severe sepsis, or septic shock. We defined a preimplementation (pre-SWAT) group and a postimplementation (post-SWAT) group and further broke these down into SWAT A (septic shock) and SWAT B (sepsis with normal systolic blood pressure). We performed extensive data comparisons in the pre-SWAT and post-SWAT groups, including demographics, systemic inflammatory response syndrome criteria, time to intravenous fluids bolus, time to antibiotics, length-of-stay times, and mortality rates. Results There were 108 patients in the pre-SWAT group and 130 patients in the post-SWAT group. The mean time to bolus was 31 minutes less in the postimplementation group, 51 vs 82 minutes (95% confidence interval, 15-46; P value < .01). The mean time to antibiotics was 59 minutes less in the postimplementation group, 81 vs 139 minutes (95% confidence interval, 44-74; P value < .01). Segmented regression modeling did not identify secular trends in these outcomes. There was no significant difference in mortality rates. Conclusions An EHR-based triage sepsis alert and SWAT protocol led to a significant reduction in the time to intravenous fluids and time to antibiotics in ED patients admitted with suspected sepsis, severe sepsis, and septic shock.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26386734</pmid><doi>10.1016/j.ajem.2015.08.039</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Anti-Bacterial Agents - therapeutic use Antibiotics Bacterial infections Clinical outcomes Clinical Protocols Confidence intervals Electronic Health Records Emergency Emergency medical care Emergency Service, Hospital Female Fluid Therapy Fluids Heart rate Hospitals Humans Infections Male Medical records Middle Aged Mortality Paging systems Patients Retrospective Studies Sepsis Sepsis - diagnosis Sepsis - mortality Sepsis - therapy Time Factors Triage |
| title | Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED |
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