Translating the Evidence of the Use of the Sepsis Screening Tool to Improve Sepsis Identification and Reduce Sepsis Mortality

2021 ◽  
Author(s):  
Nicolas Abella
Keyword(s):  
Screening Tool ◽  
Sepsis Mortality ◽  
Sepsis Screening

111 Burn Sepsis Screening Tool to Facilitate Diagnosis of Burn Sepsis

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S74-S75
Author(s):  
Kaitlyn Libraro ◽  
Palmer Bessey ◽  
Jamie Heffernan ◽  
James Gallagher
Keyword(s):  
Critically Ill ◽  
Screening Tool ◽  
Burn Injury ◽  
Clinical Signs ◽  
Case Fatality ◽  
Inhalation Injury ◽  
Clinical Feature ◽  
Sepsis Diagnosis ◽  
Acute Decompensation ◽  
Sepsis Screening

Abstract Introduction Sepsis following critical burn injury is an ominous development that can lead to death. Most patients will manifest a systemic inflammatory response syndrome (SIRS), even without being septic. This may obscure the clinical recognition of developing sepsis and delay the initiation of effective treatment. We developed a burn sepsis screening tool (BSST) to facilitate the recognition of developing burn sepsis. The purpose of this study was to review the utility of that tool. Methods The BSST was based on several clinical signs, laboratory values, and changes in physiologic support modalities associated with sepsis. It consisted of nine parameters that could be scored as indicating or not indicating sepsis or not applicable. If three were positive, the patient was identified as septic, and a search for a septic source was undertaken and treatment initiated. The BSST was completed on patients judged to be critically ill during morning rounds over a period of nine months. The values were transcribed into a secure web database and analyzed using SAS 9.4. Results There were 593 individual encounters on 31 critically ill patients with burns and/or inhalation injury for which the BSST was completed. The mean age of the patients was 57 ± 4 years (Mean ± SEM), and the burn size was 24 ± 15 % TBSA. Eleven patients were women (36%) and 7 patients had inhalation injury (23%). The expected case fatality was 21 - 30% depending on the statistical model used. Six patients (19%) died. The length of stay was 64 ± 10 days and ranged from 3 to 267 days. A patient was judged to be septic in only 45 of the daily encounters (8.0 % ± 1.1). There were 21 instances of a new septic event made in 12 patients. Episode of sepsis separated by at least 5 days of no sepsis, were considered to be a new septic event. There was a substantial amount of data that was missing or not applicable. There were no significant differences in the septic parameters on days with new sepsis diagnosis when compared to the day prior, or compared to all encounters in patients that were never septic. Patients deteriorated acutely between BSST completions on only two occasions and both were stabilized. Conclusions The BSST was used consistently to help evaluate the daily status of critically ill burn injured patients. The expected case fatality of the group was moderately high, based on statistical models derived from the ABA Burn Registry. The observed outcome was as good as or better than predicted. Acute decompensation was rare. The BSST added daily administrative work to rounds, and the data recorded were often incomplete. Although the BSST did not demonstrate any single clinical feature that identified the transition from SIRS to sepsis, it did add structure and rigor to daily rounds. That contributed to the effectiveness of rounds, and it may have been responsible, in part, for the favorable outcomes.

scholarly journals The Influence of Patient and Organizational Factors on a Hospital-Wide Sepsis Screening Tool

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Peter Shearer ◽  
Jashvant Poeran ◽  
Ken Mccardle ◽  
Madhu Mazumdar ◽  
Gopi Patel ◽  
...  
Keyword(s):  
Screening Tool ◽  
Organizational Factors ◽  
Sepsis Screening

scholarly journals Accuracy of a Qsofa Based Sepsis Screening Tool

2019 ◽  
Vol 32 ◽  
pp. S1
Author(s):  
Laura Alberto ◽  
Andrea P. Marshall ◽  
Rachel Walker ◽  
Fernando Pálizas ◽  
Leanne M. Aitken
Keyword(s):  
Screening Tool ◽  
Sepsis Screening

scholarly journals 781. Nurse-Driven Time-of-Triage Sepsis Screening Tool Improves Timely Intervention in Ambulatory Emergency Department (ED) Patients with Suspected Sepsis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S346-S347
Author(s):  
Catalina Howland ◽  
Arthur Chang ◽  
Stephen Selvanayagam ◽  
Stacy Kim ◽  
Mark Bounthavong ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Screening Tool ◽  
Early Recognition ◽  
Average Length ◽  
Primary Outcome Measure ◽  
Medical Attention ◽  
Time Interval ◽  
Antibiotic Administration ◽  
Suspected Sepsis ◽  
Sepsis Screening

Abstract Background Sepsis is a potentially life-threatening, systemic complication of infection. Rapid intervention is critical to reduce morbidity and mortality; however, early recognition of sepsis is challenging due to a highly variable and nonspecific presentation. Recognition is particularly problematic in ambulatory (walk-in) patients who receive minimal to no medical attention prior to ED presentation. There is limited literature addressing sepsis intervention among the ambulatory population in the ED. Our organization has employed an electronic, nurse-driven sepsis screening tool into the triage process for all ambulatory patients who present to the ED. Methods This was a retrospective, quasi-experimental study conducted from November 2015 to May 2018 in three consecutive timeframes: pre-implementation (12 months), implementation (7 months), and post-implementation (12 months). Adult ambulatory ED patients were included if they had a coded diagnosis of sepsis, septic shock, or an infectious syndrome, had fever or hypothermia and systemic inflammatory response syndrome signs on presentation. The primary outcome measure was hourly time interval to antibiotic administration from time of ED registration. Results A total of 902 patients were included with 286, 208, and 408 patients in the pre-implementation, implementation and post-implementation cohorts, respectively. Baseline characteristics including comorbid conditions and infection source were similar between cohorts. The primary outcome of hourly time interval to antibiotic administration was significantly different (P = 0.044) between the three cohorts with the most substantial increase in administration specifically in the less than 1-hour interval. Between the pre-implementation, implementation, and post-implementation cohorts, significant decreases were observed in mean time to fluids (3.6, 3.0, and 2.5 hours, respectively, P = 0.003) and average length of stay (5.5, 5.8, and 4.2 days, respectively, P < 0.001) and a significant increase was observed in ED sepsis alert activations (26%, 48%, 51%, respectively, P < 0.001). Conclusion A nurse-driven electronic time-of-triage sepsis screening tool improved timely recognition and intervention in ambulatory ED patients with suspected sepsis. Disclosures All authors: No reported disclosures.

NEWS and Sepsis Screening Tool

2016 ◽  
Vol 24 (2) ◽  
pp. 13-13
Author(s):  
Layla Haidrani
Keyword(s):  
Screening Tool ◽  
Sepsis Screening

scholarly journals Paramedic Recognition of Sepsis in the Prehospital Setting: A Prospective Observational Study

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Robert S. Green ◽  
Andrew H. Travers ◽  
Edward Cain ◽  
Samuel G. Campbell ◽  
Jan L. Jensen ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Screening Tool ◽  
Tertiary Hospital ◽  
Emergency Physicians ◽  
Likelihood Ratios ◽  
True Negative ◽  
Predictive Values ◽  
Study Team ◽  
Sepsis Screening

Background. Patients with sepsis benefit from early diagnosis and treatment. Accurate paramedic recognition of sepsis is important to initiate care promptly for patients who arrive by Emergency Medical Services.Methods. Prospective observational study of adult patients (age ≥ 16 years) transported by paramedics to the emergency department (ED) of a Canadian tertiary hospital. Paramedic identification of sepsis was assessed using a novel prehospital sepsis screening tool developed by the study team and compared to blind, independent documentation of ED diagnoses by attending emergency physicians (EPs). Specificity, sensitivity, accuracy, positive and negative predictive value, and likelihood ratios were calculated with 95% confidence intervals.Results. Overall, 629 patients were included in the analysis. Sepsis was identified by paramedics in 170 (27.0%) patients and by EPs in 71 (11.3%) patients. Sensitivity of paramedic sepsis identification compared to EP diagnosis was 73.2% (95% CI 61.4–83.0), while specificity was 78.8% (95% CI 75.2–82.2). The accuracy of paramedic identification of sepsis was 78.2% (492/629, 52 true positive, 440 true negative). Positive and negative predictive values were 30.6% (95% CI 23.8–38.1) and 95.9% (95% CI 93.6–97.5), respectively.Conclusion. Using a novel prehospital sepsis screening tool, paramedic recognition of sepsis had greater specificity than sensitivity with reasonable accuracy.

Implementation of an Automated Sepsis Screening Tool in a Community Hospital Setting

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Penny B. Cooper ◽  
Bobbi J. Hughes ◽  
George M. Verghese ◽  
J. Scott Just ◽  
Amy J. Markham
Keyword(s):  
Screening Tool ◽  
Community Hospital ◽  
Hospital Setting ◽  
Sepsis Screening

scholarly journals Automating a Manual Sepsis Screening Tool in a Pediatric Emergency Department

2018 ◽  
Vol 09 (04) ◽  
pp. 803-808 ◽  
Author(s):  
Julia Lloyd ◽  
Erin Ahrens ◽  
Donnie Clark ◽  
Terri Dachenhaus ◽  
Kathryn Nuss
Keyword(s):  
Emergency Department ◽  
Electronic Health Record ◽  
Screening Tool ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Health Record ◽  
Electronic Health Record Data ◽  
Electronic Tool ◽  
Electronic Health ◽  
Sepsis Screening

Objective This article describes the method of integrating a manual pediatric emergency department sepsis screening process into the electronic health record that leverages existing clinical documentation and keeps providers in their current, routine clinical workflows. Methods Criteria in the manual pediatric emergency department sepsis screening tool were mapped to standard documentation routinely entered in the electronic health record. Data elements were extracted and scored from the medical history, medication record, vital signs, and physical assessments. Scores that met a predefined sepsis risk threshold triggered interruptive system alerts which notified emergency department staff to perform sepsis huddles and consider appropriate interventions. Statistical comparison of the new electronic tool to the manual process was completed by a two-tail paired t-test. Results The performance of the pediatric electronic sepsis screening tool was evaluated by comparing flowsheet row documentation of the manual, sepsis alert process against the interruptive system alert instance of the electronic sepsis screening tool. In an 8-week testing period, the automated pediatric electronic sepsis screening tool identified 100% of patients flagged by the manual process (n = 29), on average, 68 minutes earlier. Conclusion Integrating a manual sepsis screening tool into the electronic health record automated identification of pediatric sepsis screening in a busy emergency department. The electronic sepsis screening tool is as accurate as a manual process and would alert bedside clinicians significantly earlier in the emergency department course. Deployment of this electronic tool has the capability to improve timely sepsis detection and management of patients at risk for sepsis without requiring additional documentation by providers.

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