Christopher L Hunter1, Salvatore Silvestri2, Amanda Stone2, Anne Shaughnessy2, Stacie Miller2, Alexa Rodriguez2, Linda Papa3. 1. Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL, United States of America; University of Central Florida College of Medicine, Orlando, FL, United States of America. Electronic address: christopher.hunter@orlandohealth.com. 2. Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL, United States of America. 3. Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL, United States of America; University of Central Florida College of Medicine, Orlando, FL, United States of America.
Abstract
OBJECTIVE: To determine if prehospital identification of sepsis will affect time to Centers for Medicare and Medicaid services (CMS) sepsis core measures and improve clinical outcomes. METHODS: We conducted a retrospective cohort study among septic patients who were identified as "sepsis alerts" in the emergency department (ED). Metrics including time from ED registration to fluid resuscitation, blood cultures, serum lactate draws, and antibiotics administration were compared between those who had pre-arrival notification by EMS versus those that did not. Additionally, outcomes such as mortality and intensive care unit (ICU) admission were recorded. RESULTS: Of the 272 total patients, 162 had pre-arrival notification (prehospital sepsis alerts) and 110 did not. The prehospital sepsis alert group had significantly lower times to intravenous fluid administration (6 min 95%CI 4-9 min vs 41 min 95%CI 24-58 min, p < 0.001), blood cultures drawn (12 min 95%CI 10-14 min vs 34 min 95%CI 20-48 min, p = 0.003), lactate levels drawn (12 min 95%CI 10-15 min vs 34 min 95%CI 20-49 min, p = 0.003), and administration of antibiotics (33 min 95%CI 26-40 min vs 61 min 95%CI 44-78 min, p = 0.004). Patients with prehospital sepsis alerts also had a higher admission rate (100% vs 95%, p = 0.006), and a lower ICU admission rate (33% vs 52%, p = 0.003). There was no difference in mortality (11% vs 14%, p = 0.565) between groups. CONCLUSIONS: Prehospital sepsis alert notification may decrease time to specific metrics shown to improve outcomes in sepsis.
OBJECTIVE: To determine if prehospital identification of sepsis will affect time to Centers for Medicare and Medicaid services (CMS) sepsis core measures and improve clinical outcomes. METHODS: We conducted a retrospective cohort study among septicpatients who were identified as "sepsis alerts" in the emergency department (ED). Metrics including time from ED registration to fluid resuscitation, blood cultures, serum lactate draws, and antibiotics administration were compared between those who had pre-arrival notification by EMS versus those that did not. Additionally, outcomes such as mortality and intensive care unit (ICU) admission were recorded. RESULTS: Of the 272 total patients, 162 had pre-arrival notification (prehospital sepsis alerts) and 110 did not. The prehospital sepsis alert group had significantly lower times to intravenous fluid administration (6 min 95%CI 4-9 min vs 41 min 95%CI 24-58 min, p < 0.001), blood cultures drawn (12 min 95%CI 10-14 min vs 34 min 95%CI 20-48 min, p = 0.003), lactate levels drawn (12 min 95%CI 10-15 min vs 34 min 95%CI 20-49 min, p = 0.003), and administration of antibiotics (33 min 95%CI 26-40 min vs 61 min 95%CI 44-78 min, p = 0.004). Patients with prehospital sepsis alerts also had a higher admission rate (100% vs 95%, p = 0.006), and a lower ICU admission rate (33% vs 52%, p = 0.003). There was no difference in mortality (11% vs 14%, p = 0.565) between groups. CONCLUSIONS: Prehospital sepsis alert notification may decrease time to specific metrics shown to improve outcomes in sepsis.
Authors: Gideon H P Latten; Lieke Claassen; Marnix Jonk; Jochen W L Cals; Jean W M Muris; Patricia M Stassen Journal: PLoS One Date: 2019-02-07 Impact factor: 3.240