Sepsis

Evolving sepsis definitions and their impact on Acute Medical Units

Research Audit and Clinical Practice, Volume 16, Issue 1, Pages 1 – 48 (2017)

Background: There are currently several different definitions for sepsis. This study looked at what proportion of acute medical admissions were identified by the different definitions, what correlation they have, and how many patients would require a review with results in 1 hour.

Methods: Data on 212 admissions was collected, on time of admission and review, and number of patients with sepsis by each diagnostic criteria calculated.

Results: The NICE criteria identified 69% of admissions as requiring review within one hour, compared to 6% with qSOFA and 18% with previous sepsis definitions. The mean time to review was 1hr 18min, and only 50% of patients meeting the NICE criteria were reviewed within one hour.

Conclusions: The proposed NICE guidance will be challenging to implement with current resources.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Evolving sepsis definitions and their impact on Acute Medical Units Read More

Study protocol for a Multi-centre, Investigator-initiated, Randomized Controlled Trial to Compare the Effects of Prehospital Antibiotic Treatment for Sepsis Patients with Usual Care after Training Emergency Medical Services (EMS) Personnel in Early Recognition (– The Prehospital ANTibiotics Against Sepsis (PHANTASi) trial

Research Audit and Clinical Practice, Volume 15, Issue 4, Pages 165 – 220 (2016)

Abstract

Introduction: Sepsis is one of the most frequent reasons for referral to emergency departments (EDs) worldwide. Sepsis becomes more serious when left untreated with a high mortality rate, exceeding even those of myocardial infarction and stroke. Therefore, much effort has been put in to start with appropriate therapy as early as possible. Emergency medical services (EMS) personnel have already made a significant difference in improving care for patients with acute coronary syndrome, multiple trauma and stroke. Patients with severe sepsis or septic shock could also benefit from timely prehospital care. Earlier recognition and initiation of treatment by EMS personnel may improve survival of these critically ill patients.

Methods and analysis: The Prehospital Antibiotics against Sepsis (PHANTASi) trial is an investigator- initiated, multicentre, randomized controlled open-label clinical trial nested within a step wedge design. This study compares the effects of usual care to that of training EMS personnel in recognizing and initiating treatment in the prehospital setting together with early administration of antibiotics for patients suspected of (severe) sepsis and septic shock. Primary outcome is 28 day mortality. Secondary outcomes include, length of hospital stay and admission to intensive care units.

Ethics and dissemination: This study has been approved by the research ethics committee of VU University Medical Centre, Amsterdam, The Netherlands (Protocol 2013.458/ NL 42001.029.13). The results of the study will be disseminated at several research conferences and international peer reviewed journals. The study will be implemented and reported in line with the CONSORT statement.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Study protocol for a Multi-centre, Investigator-initiated, Randomized Controlled Trial to Compare the Effects of Prehospital Antibiotic Treatment for Sepsis Patients with Usual Care after Training Emergency Medical Services (EMS) Personnel in Early Recognition (– The Prehospital ANTibiotics Against Sepsis (PHANTASi) trial Read More

Epidemiology, recognition and documentation of sepsis in the pre-hospital setting and associated clinical outcomes: a prospective multicenter study

Research Audit and Clinical Practice, Volume 15, Issue 4, Pages 165 – 220 (2016)

Introduction: General practitioners (GPs) and the emergency medical services (EMS) personnel have a pivotal role as points of entry into the acute care chain. This study was conducted to investigate the recognition of sepsis by GPs and EMS personnel and to evaluate the associations between recognition of sepsis in the pre-hospital setting and patient outcomes.

Methods
Design: prospective, observational study during a 12 week period in the emergency department (ED) of two academic hospitals.

Study population: Patients >18 years presenting with sepsis at the ED. The information available in the ED discharge letter and the ED charts was used to make a definite diagnosis of sepsis, severe sepsis and septic shock Outcome measures: primary: recognition/documentation of sepsis. Secondary: ED arrival time to antibiotic administration, in-hospital mortality, hospital length of stay (LOS) and intensive care unit (ICU) admission.

Results: A total of 301 patients were included in the study. GPs and EMS personnel correctly identified and documented 31.6% (n=114) and 41.4% of all sepsis patients (n=140) respectively. Recognition and documentation of sepsis improved with increasing severity. The mean time to administration of antibiotics (TTA) was nearly halved for the group of patients where sepsis was documented (GP: 66,4 minutes, EMS: 65,6 minutes) compared to the group in which sepsis was not documented (GP: 123,9 minutes, EMS: 101,5 minutes; p= 0.365 and p= 0.024 respectively).

Conclusions: There is room for improvement in the recognition of sepsis, severe sepsis and septic shock by practitioners working in the pre-hospital setting. Documentation of sepsis prior to arrival in hospital led to a reduced time delay in administration of antibiotics.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Epidemiology, recognition and documentation of sepsis in the pre-hospital setting and associated clinical outcomes: a prospective multicenter study Read More

Ambulatory Outpatient Management of patients with low risk febrile neutropaenia

Trainee Section, Volume 14, Issue 4, Pages 145 - 196 (2015)

Patients with febrile neutropenia are a heterogeneous group with only a minority developing significant medical complications. Scoring systems, such as the Multinational Association for Supportive Care in Cancer (MASCC) score, have been developed and validated to identify low risk patients. Caring for patients with low risk febrile neutropenia in an ambulatory setting is proven to be safe and effective. Benefits include admission avoidance, cost savings and reduced risk of nosocomial infections, as well as improved patient experience and satisfaction. Implementation of an ambulatory pathway for low risk febrile neutropenia provides an excellent opportunity for Acute Physicians and Oncologists to collaborate in delivering care for this group of patients.

Ambulatory Outpatient Management of patients with low risk febrile neutropaenia Read More

Effectiveness of early antibiotic administration in septic patients with cancer

Research Audit and Clinical Practice, Volume 12, Issue 4, Pages 185 - 252 (2013)

Abstract

Introduction: First dose intravenous antimicrobial therapy should be administered within 1 hour of admission but this is achieved in a minority of patients..

Methods: We performed a retrospective analysis at the largest Oncology hospital in Europe. Nurse-led administration of initial antibiotic therapy was introduced to the admissions unit.

Results: The nurse led protocol increased compliance with the 1 hour target from 40% to 88.6%. There was a statistically significant decrease in the mean length of stay (p=0.045) which was more pronounced in the neutropenic population (p=0.006). There was a trend to improved 30 day mortality.

Conclusions: A nurse led protocol can be effective in improving compliance with the 1 hour target. Early administration of intravenous antibiotics in cancer patients with sepsis is associated with a shorter length of inpatient stay and a trend to decreased mortality.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Effectiveness of early antibiotic administration in septic patients with cancer Read More

Severe Sepsis, Social Media and the #Sepsis 6: ‘Tweeting’ National Innovations

Research Audit and Clinical Practice, Volume 12, Issue 2, Pages 65 - 124 (2013)

Abstract

The Surviving Sepsis Campaign (SSC) was launched in 2002 with guidelines created to help manage severe sepsis and septic shock. In response to poor compliance with the SSC guidelines in the UK, the ‘Sepsis 6’ model of delivery was created. We report some of the innovative methods hospitals from around the UK are using to help deliver the ‘Sepsis 6’ care bundle. The use of social media, such as Twitter, for disseminating these innovations is also explored.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Severe Sepsis, Social Media and the #Sepsis 6: ‘Tweeting’ National Innovations Read More

An unexpected cause of sepsis in a patient with dental decay (Answers)

Picture Quiz, Volume 12, Issue 1, Pages 1 - 64 (2013)

The patient underwent transthoracic echocardiography which confirmed the presence of a calcified intracardiac mass in the right atrium, with significant tricuspid insufficiency and compression of the left atrium (Figure 2). CT angiography of the thorax revealed the tumour was 7.2x5.3x4.4 cm. Initially, no pulmonary vascular abnormalities were seen.

Please subscribe to see more.
Subscribe
Already a member? Log in here

An unexpected cause of sepsis in a patient with dental decay (Answers) Read More

An unexpected cause of sepsis in a patient with dental decay

Picture Quiz, Volume 12, Issue 1, Pages 1 - 64 (2013)

A 42-year old man attended our emergency department with sudden onset of nausea, fever and cold sweats. In the days prior to presentation, he had developed a radiating pain in the thoracic spine. Furthermore, he had been suffering from dyspnoea on exertion for several weeks. He was a smoker, but had no significant past medical history.

An unexpected cause of sepsis in a patient with dental decay Read More

Towards ‘Sepsis with Optimal Treatment’: Evaluating the sepsis care pathway in Acute Medicine and identifying scope for systems improvement

Research Audit and Clinical Practice, Volume 12, Issue 1, Pages 1 - 64 (2013)

Abstract

Sepsis commonly presents to the acute medicine unit (AMU). Timely recognition and treatment can reduce the significant associated mortality, but United Kingdom AMUs and emergency departments are often inadequately equipped to manage sepsis with early-goal directed therapy.

We conducted an observational study of 50 consecutive patients admitted with severe sepsis. Demographic, physiological and microbiological data, and information about the provision and timing of care were collected in real time.

Treatment fell below “surviving sepsis” targets with only 28% of patients receiving sufficient fluid, and 64% receiving antibiotics within 3 hours, associated with delays in seeing physicians; however despite this mortality was lower than the nationally quoted average (14% at 90 days).

Please subscribe to see more.
Subscribe
Already a member? Log in here

Towards ‘Sepsis with Optimal Treatment’: Evaluating the sepsis care pathway in Acute Medicine and identifying scope for systems improvement Read More

Shopping Basket
Scroll to Top

Start typing and press enter to search

Start typing and press enter to search