医生分诊与改善儿科败血症护理之间的因果关系:单中心急诊科经验。

IF 1.2 Q3 PEDIATRICS
Pediatric quality & safety Pub Date : 2023-05-29 eCollection Date: 2023-05-01 DOI:10.1097/pq9.0000000000000651
Ganga S Moorthy, Jordan S Pung, Neel Subramanian, B Jason Theiling, Emily C Sterrett
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引用次数: 0

摘要

在美国,每年约有 75,000 名儿童因败血症住院,估计死亡率为 5%-20%。结果与败血症识别和抗生素应用的及时性密切相关:2020 年春季成立的多学科败血症工作组旨在评估和改善儿科急诊室(ED)的儿科败血症护理。电子病历识别了 2015 年 9 月至 2021 年 7 月期间的儿科败血症患者。我们使用统计过程控制图(X̄-S 图)分析了脓毒症识别时间和抗生素给药的数据。我们确定了特殊原因变异,布拉德福德-希尔标准指导多学科讨论,以确定最可能的原因:2018 年秋季,从急诊室到达到下达血液培养单的平均时间缩短了 1.1 小时,从到达到使用抗生素的时间缩短了 1.5 小时。经过定性审查,特别工作组假设,作为急诊室分诊的一部分,启动主治级儿科医生分诊(P-PIT)与观察到的败血症护理改善在时间上有关。P-PIT 将提供者首次检查的平均时间缩短了 14 分钟,并在急诊室分配前引入了医生评估流程:结论:由主治医生进行及时评估可缩短脓毒症识别时间,并为急诊室患儿提供抗生素。实施 P-PIT 计划并由主治医生进行早期评估是其他医疗机构的一个可行策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Causal Association of Physician-in-Triage with Improved Pediatric Sepsis Care: A Single-Center, Emergency Department Experience.

Causal Association of Physician-in-Triage with Improved Pediatric Sepsis Care: A Single-Center, Emergency Department Experience.

Causal Association of Physician-in-Triage with Improved Pediatric Sepsis Care: A Single-Center, Emergency Department Experience.

Approximately 75,000 children are hospitalized for sepsis yearly in the United States, with 5%-20% mortality estimates. Outcomes are closely related to the timeliness of sepsis recognition and antibiotic administration.

Methods: A multidisciplinary sepsis task force formed in the Spring of 2020 aimed to assess and improve pediatric sepsis care in the pediatric emergency department (ED). The electronic medical record identified pediatric sepsis patients from September 2015 to July 2021. Data for time to sepsis recognition and antibiotic delivery were analyzed using statistical process control charts (X̄-S charts). We identified special cause variation, and Bradford-Hill Criteria guided multidisciplinary discussions to identify the most probable cause.

Results: In the fall of 2018, the average time from ED arrival to blood culture orders decreased by 1.1 hours, and the time from arrival to antibiotic administration decreased by 1.5 hours. After qualitative review, the task force hypothesized that initiation of attending-level pediatric physician-in-triage (P-PIT) as a part of ED triage was temporally associated with the observed improved sepsis care. P-PIT reduced the average time to the first provider exam by 14 minutes and introduced a process for physician evaluation before ED room assignment.

Conclusions: Timely assessment by an attending-level physician improves time to sepsis recognition and antibiotic delivery in children who present to the ED with sepsis. Implementing a P-PIT program with early attending-level physician evaluation is a potential strategy for other institutions.

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CiteScore
2.20
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