Chih-Chang Liu1, Wan-Hua Annie Hsieh2, Pei-Fang Lai3, Sheng-Chuan Hu1,3,4, Hui-Yi Huang5, Zen Lang Bih1. 1. Lotung Poh-Ai Hospital Emergency Department Yilan Taiwan. 2. Tzu-chi University Department of Public Health Hualien Taiwan. 3. Hualien Tzu-chi General Hospital Emergency Physician Hualien Taiwan. 4. Lotung Poh-Ai Hospital Senior Adviser Yilan Taiwan. 5. Lotung Poh-Ai Hospital Nursing Practitioner Yilan Taiwan.
Abstract
BACKGROUND: A retrospective review was conducted, examining patient charts at a community hospital in Eastern Taiwan during a 2-year period, from April 2013 to March 2015. AIMS: The goal was assessment of adherence to quality indicators (QIs) in septic shock and severe sepsis (4S status) by emergency physicians (EPs). METHODS: Based on the Surviving Sepsis Campaign (SSC) guidelines, data was electronically retrieved from the Hospital Information System (HIS); and beginning in April 2014, our staff was regularly educated on this topic during monthly meetings. A Sepsis Bundle Care Set (SBCS) was also launched in September 2014. The Chi-square post hoc test was utilized in statistical analysis, setting signifi cance at p < 0.05. In patients with septic shock (n = 81) or severe sepsis (n = 572), QIs before and after educational initiatives were 36 vs. 45 and 259 vs. 313, respectively. RESULTS: In terms of septic shock, QIs that improved signifi cantly after education were C-reactive protein (CRP: 66.67% vs. 91.11%), arterial blood gas (ABG: 58.33% vs. 80.00%), and intravenous (IV)-fluid infusion rate (0.00% vs. 40.00%). QIs that significantly improved in the context of severe sepsis were CRP (59.46% vs. 84.66%), serum lactate (75.68% vs. 86.26%), intensive care unit (ICU) admission within 4 hours (72.97% vs. 81.79%), and IV-fluid infusion rate (0.00% vs. 18.85%). In comparing QI adherence rates by educational period subsets, two-set IV line showed signifi cant improvement after 7 months of education, and admission to ICU within 4 hours after 4 months of education. However, most QIs associated with severe sepsis (except serum lactate and antibiotic given in 1 hour) showed signifi cant improvement after 3 months of education. CONCLUSIONS: We concluded that there is much room to improve QI adherence rates in patients with 4S status, using educational initiatives.
BACKGROUND: A retrospective review was conducted, examining patient charts at a community hospital in Eastern Taiwan during a 2-year period, from April 2013 to March 2015. AIMS: The goal was assessment of adherence to quality indicators (QIs) in septic shock and severe sepsis (4S status) by emergency physicians (EPs). METHODS: Based on the Surviving Sepsis Campaign (SSC) guidelines, data was electronically retrieved from the Hospital Information System (HIS); and beginning in April 2014, our staff was regularly educated on this topic during monthly meetings. A Sepsis Bundle Care Set (SBCS) was also launched in September 2014. The Chi-square post hoc test was utilized in statistical analysis, setting signifi cance at p < 0.05. In patients with septic shock (n = 81) or severe sepsis (n = 572), QIs before and after educational initiatives were 36 vs. 45 and 259 vs. 313, respectively. RESULTS: In terms of septic shock, QIs that improved signifi cantly after education were C-reactive protein (CRP: 66.67% vs. 91.11%), arterial blood gas (ABG: 58.33% vs. 80.00%), and intravenous (IV)-fluid infusion rate (0.00% vs. 40.00%). QIs that significantly improved in the context of severe sepsis were CRP (59.46% vs. 84.66%), serum lactate (75.68% vs. 86.26%), intensive care unit (ICU) admission within 4 hours (72.97% vs. 81.79%), and IV-fluid infusion rate (0.00% vs. 18.85%). In comparing QI adherence rates by educational period subsets, two-set IV line showed signifi cant improvement after 7 months of education, and admission to ICU within 4 hours after 4 months of education. However, most QIs associated with severe sepsis (except serum lactate and antibiotic given in 1 hour) showed signifi cant improvement after 3 months of education. CONCLUSIONS: We concluded that there is much room to improve QI adherence rates in patients with 4S status, using educational initiatives.
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