OBJECTIVES: To describe the characteristics of early management of severe sepsis and septic shock in a hospital emergency department that does not have a specific triage category to identify patients in these states. To determine opportunities for improvement. MATERIAL AND METHODS: Prospective cohort study from March 2014 to March 2015. On each day during the study period, we included the first patient with signs compatible with septic shock. We recorded the severity level assigned according to the Andorran Triage Model and the main clinical and epidemiological variables. Patients were followed until hospital discharge. RESULTS: Fifty patients (35 men) with septic shock (mean age 65 years) were included. Thirty-five were at triage level 1 or 2 and 15 were at level 3. Patients initially classified as level 1-2 had significantly higher heart rates than level 3 patients (mean 110 vs 90 bpm, respectively; P=.003) and respiratory rates (mean 27 vs 18 breaths per minute; P=.001). Patients classified as level 1-2 also had significantly shorter care times than level 3 patients: time from arrival to examination room entry, 18 vs 117 minutes, respectively (P=.002); time from arrival to the first antibiotic dose (85 vs 231 minutes (P=.001). CONCLUSION: Medical care for patients with septic shock in this emergency department needs to improve in terms of earlier diagnosis and better compliance with guidelines for initial therapeutic management.
OBJECTIVES: To describe the characteristics of early management of severe sepsis and septic shock in a hospital emergency department that does not have a specific triage category to identify patients in these states. To determine opportunities for improvement. MATERIAL AND METHODS: Prospective cohort study from March 2014 to March 2015. On each day during the study period, we included the first patient with signs compatible with septic shock. We recorded the severity level assigned according to the Andorran Triage Model and the main clinical and epidemiological variables. Patients were followed until hospital discharge. RESULTS: Fifty patients (35 men) with septic shock (mean age 65 years) were included. Thirty-five were at triage level 1 or 2 and 15 were at level 3. Patients initially classified as level 1-2 had significantly higher heart rates than level 3 patients (mean 110 vs 90 bpm, respectively; P=.003) and respiratory rates (mean 27 vs 18 breaths per minute; P=.001). Patients classified as level 1-2 also had significantly shorter care times than level 3 patients: time from arrival to examination room entry, 18 vs 117 minutes, respectively (P=.002); time from arrival to the first antibiotic dose (85 vs 231 minutes (P=.001). CONCLUSION: Medical care for patients with septic shock in this emergency department needs to improve in terms of earlier diagnosis and better compliance with guidelines for initial therapeutic management.
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Keywords:
Estrategiaszzm321990de mejora; First-hour antibiotic therapy; Improvement strategies; Patient safety; Seguridad del paciente; Sepsis grave; Septic shock; Severe sepsis; Shock séptico; Tratamiento antibiótico en la primera hora
Authors: J González Del Castillo; A Julian-Jiménez; F González-Martínez; J Álvarez-Manzanares; P Piñera; C Navarro-Bustos; M Martinez-Ortiz de Zarate; F Llopis-Roca; M Debán Fernández; J Gamazo-Del Rio; E J García-Lamberechts; F J Martín-Sánchez Journal: Eur J Clin Microbiol Infect Dis Date: 2017-07-28 Impact factor: 3.267
Authors: Diana Carolina López-Medina; Marcela Henao-Perez; Jaime Arenas-Andrade; Emel David Hinestroza-Marín; Fabián Alberto Jaimes-Barragán; Oscar Iván Quirós-Gómez Journal: Rev Bras Ter Intensiva Date: 2020-05-08
Authors: A Julián-Jiménez; I Adán Valero; A Beteta López; L M Cano Martín; O Fernández Rodríguez; R Rubio Díaz; M A Sepúlveda Berrocal; J González Del Castillo; F J Candel González Journal: Rev Esp Quimioter Date: 2018-04-05 Impact factor: 1.553