肿瘤急诊科脓毒症综合项目

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-08-16 DOI:10.1016/j.jemermed.2025.04.042

John Stroh MD, Patricia Brock MD, Olivia Lennon MS, Rowena Montoya RN, Serah Homena RN, Rachel Gansit RN, Alyssa Hughes RN

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引用次数: 0

摘要

德克萨斯大学MD安德森癌症中心的急诊科已经实施了一种多学科方法来处理到达急诊科的疑似败血症患者。败血症项目包括：电子健康记录最佳实践咨询，跨学科文本警报和开销页面。该计划还包括一个跨学科团队，审查所有不符合败血症包的败血症病例。脓毒症程序包括两个主要组成部分：识别和脓毒症审查。如果患者符合两个mSIRS标准，则触发败血症BPA。在触发BPA或基于临床判断时，分诊护士启动脓毒症参数命令，并通过开销页面和跨学科文本消息激活脓毒症反应。回顾：每两个月召开一次脓毒症脉搏检查会议，以便与跨学科团队进行病例讨论。在每次会议之前，护士回顾前一周的所有败血症后果，并与护理领导、指定的医师审查员和药剂师分享发现。护士在会议期间介绍病例，促进跨学科合作以改进。这使团队能够共同努力，确定护理方面的差距，并跟进所需的任何变化。与美国的综合癌症中心相比，我们的机构一直保持着最低的败血症死亡率指数。从2023财政年度到2024财政年度，该部门提高了一小时内抗生素给药门的合规性（平均从55%提高到73.8%）。平均到抗生素的时间从87分钟减少到59分钟。在整个2024财政年度，该部门对抗生素的依从性从到货到给药在60分钟内增加。在财政年度的三个月内，该部门也100%遵守了在三小时内使用抗生素的规定。这是该部门第一次100%遵守三小时标准。脓毒症项目强调提高急诊护理质量的价值，实现早期脓毒症检测、及时干预和有效的团队协调。正在进行的审查推动流程改进并改善患者预后。

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Comprehensive Sepsis Program in the Oncology Emergency Department

The Emergency Department at the University of Texas MD Anderson Cancer Center has implemented a multidisciplinary approach to address suspected sepsis patients that arrive to the emergency department. The sepsis program includes: an electronic health record best practice advisory, interdisciplinary text alert and overhead page. The program also includes an interdisciplinary team which reviews all sepsis cases that do not meet the sepsis bundle.

The sepsis program is comprised of two main components: recognition and sepsis review.

Recognition
If the patient meets two mSIRS criteria the sepsis BPA is triggered. Upon trigger of the BPA or based on clinical judgement the triage RN initiates the sepsis parameter orders and activate the sepsis response by both overhead page and interdisciplinary text message.
Review
Bi-monthly Sepsis Pulse Check meetings enable case discussion with the interdisciplinary team. Before each meeting, nurses review all sepsis fallouts from the preceding week and share findings with nursing leadership, assigned physician reviewers and pharmacist. Nurses present cases during meetings, fostering interdisciplinary collaboration for improvements. This allows the team to work together to identify gaps in care and follow up on any changes that are needed.

Our institution has maintained the lowest sepsis mortality index compared to comprehensive cancer centers in the United States. The department has improved door to antibiotic administration within one hour compliance from fiscal year 2023 to 2024 (mean from 55% to 73.8%). Mean door to antibiotic time decreased from 87 minutes to 59 minutes. The department compliance to antibiotics from arrival to administration in sixty minutes increased throughout the fiscal year 2024. The department also had one hundred percent compliance for door to antibiotic time within three hours in three months out of the fiscal year. This being the first time the department has achieved one hundred percent compliance with the three-hour metric. The Sepsis Program highlights the value of quality improvement in emergency care, enabling early sepsis detection, timely interventions, and efficient team coordination. Ongoing reviews drive process enhancements and improve patient outcomes.

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine