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sepsis alert

Martin Carberry, John Harden
Early identification of patients with sepsis is key to the delivery of the sepsis 6 bundle including antibiotic therapy within an hour.[1-3] Demand versus capacity challenges in the Emergency Department (ED) led to delays in antibiotic and sepsis 6 delivery. An alerting tool was developed that provided criteria for Scottish Ambulance Service (SAS) Paramedics to alert the ED of potential sepsis patients. Data from patients presenting to the ED prior to the alerting process commencing (n=50) and during alerting (n=50) were analysed, a questionnaire was used to ascertain feedback from all staff groups; nurses doctors, and paramedics (n=38)...
2016: BMJ Quality Improvement Reports
Laurel A Despins
Severe sepsis and septic shock are global issues with high mortality rates. Early recognition and intervention are essential to optimize patient outcomes. Automated detection using electronic medical record (EMR) data can assist this process. This review describes automated sepsis detection using EMR data. PubMed retrieved publications between January 1, 2005 and January 31, 2015. Thirteen studies met study criteria: described an automated detection approach with the potential to detect sepsis or sepsis-related deterioration in real or near-real time; focused on emergency department and hospitalized neonatal, pediatric, or adult patients; and provided performance measures or results indicating the impact of automated sepsis detection...
September 13, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
Catarina Cardoso de Almeida, Susana Maria Saraiva Pissarra da Silva, Filipa Silveira Dias Flor de Lima Caldas de Oliveira, Maria Hercília Ferreira Guimarães Pereira Areias
OBJECTIVE: To evaluate nosocomial infections preventive bundle, implemented in April 2010 in Centro Hospitalar de São João (CHSJ) Neonatal Intensive Care Unit (NICU) effectiveness. METHODS: Newborns admitted to level-III NICU of CHSJ, between 1 April 2007 and 31 March 2013, with sepsis as discharge diagnosis, were selected and divided into two periods (Period 1 and 2, before and after new preventive bundle introduction). Data from the two periods were compared...
October 3, 2016: Journal of Maternal-fetal & Neonatal Medicine
Samuel M Brown, Jason Jones, Kathryn Gibb Kuttler, Roger K Keddington, Todd L Allen, Peter Haug
BACKGROUND: Sepsis is an often-fatal syndrome resulting from severe infection. Rapid identification and treatment are critical for septic patients. We therefore developed a probabilistic model to identify septic patients in the emergency department (ED). We aimed to produce a model that identifies 80 % of sepsis patients, with no more than 15 false positive alerts per day, within one hour of ED admission, using routine clinical data. METHODS: We developed the model using retrospective data for 132,748 ED encounters (549 septic), with manual chart review to confirm cases of severe sepsis or septic shock from January 2006 through December 2008...
August 22, 2016: BMC Emergency Medicine
Ian Anderson
There are several secondary care early warning scores which alert for severe illness including sepsis. None are specifically adjusted for primary care. A Primary Health Early Warning Score (PHEWS) is proposed which incorporates practical parameters from both secondary and primary care.
March 2016: Journal of Primary Health Care
Anish K Agarwal, David F Gaieski, Sarah M Perman, Marion Leary, Gail Delfin, Benjamin S Abella, Brendan G Carr
BACKGROUND: Protocol-based resuscitation strategies in the Emergency Department (ED) improve survival for out-of-hospital cardiac arrest (OHCA) and severe sepsis but implementation has been inconsistent. OBJECTIVE: To determine the feasibility of a real-time provider-to-provider telemedical intervention for the treatment of OHCA and severe sepsis. MATERIALS AND METHODS: A three-center pilot study utilizing a "hub-spoke model" with an academic medical center acting both as the hub for teleconsultation as well as a spoke hospital enrolling patients...
April 2016: Heliyon
Joshua Rolnick, N Lance Downing, John Shepard, Weihan Chu, Julia Tam, Alexander Wessels, Ron Li, Brian Dietrich, Michael Rudy, Leon Castaneda, Lisa Shieh
BACHGROUND: Increasing use of EHRs has generated interest in the potential of computerized clinical decision support to improve treatment of sepsis. Electronic sepsis alerts have had mixed results due to poor test characteristics, the inability to detect sepsis in a timely fashion and the use of outside software limiting widespread adoption. We describe the development, evaluation and validation of an accurate and timely severe sepsis alert with the potential to impact sepsis management...
2016: Applied Clinical Informatics
Cody Benthin, Sonal Pannu, Akram Khan, Michelle Gong
RATIONALE: The nature, variability and extent of early warning clinical practice alerts derived from automated query of electronic health records (e-alerts) currently employed in acute care settings for clinical care or research is unknown. OBJECTIVES: To describe e-alerts in current use in acute care settings at medical centers participating in a nationwide critical care research network. METHODS: We surveyed investigators at 38 institutions involved in the NIH-funded Clinical Trials Network for the Prevention and Early Treatment of Acute Lung Injury (PETAL) for quantitative and qualitative analysis...
July 12, 2016: Annals of the American Thoracic Society
Poushali Bhattacharjee, Dana P Edelson, Matthew M Churpek
Sepsis contributes to up to half of all deaths in hospitalized patients, and early interventions, such as appropriate antibiotics, have been shown to improve outcomes. Most research has focused on early identification and treatment of septic patients in the emergency department and the intensive care unit; however, many patients develop sepsis on the general wards. The goal of this review is to discuss recent advances in sepsis detection in patients on the hospital wards. It will discuss data highlighting the benefits and limitations of the systemic inflammatory response syndrome (SIRS) criteria for screening septic patients, such as its low specificity, as well as newly described scoring systems, including the proposed role of the quick Sepsis-related Organ Failure Assessment (qSOFA) score...
June 30, 2016: Chest
Andrew McGregor, Khaldoun Bekdache, Laura Choi
INTRODUCTION: Pneumatosis intestinalis (PI) and hepatic portal venous gas (HPVG) are radiographic signs of questionable bowel ischemia. Pneumatosis intestinalis can be associated with possible benign conditions such as obstructive airway disease. We present a patient who demonstrated clinical signs of overt sepsis with corresponding radiological findings of PI and HPVG concering for possible small or large bowel ischemia. However at exploration, no sign of small or large bowel injury or ischemia could be detected...
May 2016: Connecticut Medicine
R Zaragoza, S Sancho, C Hurtado, J Camarena, R González, S Borrás, M Cervera
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
Evelyn M Olenick, Kathie S Zimbro, Gabrielle M DʼLima, Patricia Ver Schneider, Danielle Jones
The Sepsis "Sniffer" Algorithm (SSA) has merit as a digital sepsis alert but should be considered an adjunct to versus an alternative for the Nurse Screening Tool (NST), given lower specificity and positive predictive value. The SSA reduced the risk of incorrectly categorizing patients at low risk for sepsis, detected sepsis high risk in half the time, and reduced redundant NST screens by 70% and manual screening hours by 64% to 72%. Preserving nurse hours expended on manual sepsis alerts may translate into time directed toward other patient priorities...
June 6, 2016: Journal of Nursing Care Quality
Andrew M Harrison, Ognjen Gajic, Brian W Pickering, Vitaly Herasevich
Development and implementation of sepsis alert systems is challenging, particularly outside the monitored intensive care unit (ICU) setting. Barriers to wider use of sepsis alerts include evolving clinical definitions of sepsis, information overload, and alert fatigue, due to suboptimal alert performance. Outside the ICU, barriers include differences in health care delivery models, charting behaviors, and availability of electronic data. Current evidence does not support routine use of sepsis alert systems in clinical practice...
June 2016: Clinics in Chest Medicine
Sharad Manaktala, Stephen R Claypool
OBJECTIVE: We created a system using a triad of change management, electronic surveillance, and algorithms to detect sepsis and deliver highly sensitive and specific decision support to the point of care using a mobile application. The investigators hypothesized that this system would result in a reduction in sepsis mortality. METHODS: A before-and-after model was used to study the impact of the interventions on sepsis-related mortality. All patients admitted to the study units were screened per the Institute for Healthcare Improvement Surviving Sepsis Guidelines using real-time electronic surveillance...
May 25, 2016: Journal of the American Medical Informatics Association: JAMIA
Marwan Idrees, Stephen Pj Macdonald, Kiren Kodali
INTRODUCTION: The Surviving Sepsis Campaign guidelines recommend administration of appropriate antibiotics within 1 h in patients with severe sepsis, with two sets of blood cultures taken prior to administration. OBJECTIVE: We evaluated the effect of introducing a Sepsis Early Alert Tool (SEAT) in the ED. Outcomes were antibiotic timing, antibiotic choice and obtaining adequate blood cultures. METHODS: A retrospective chart review compared consecutive severe sepsis presentations admitted to ICU via the ED during two equivalent 6 month periods before and after SEAT introduction...
August 2016: Emergency Medicine Australasia: EMA
J Botten, J Beard, A Zorzi, A Thompson
OBJECTIVES: Patients with suspected Neutropenic sepsis require rapid antibiotic administration, but despite extensive education, only 67% of patients received antibiotics within 60 minutes . METHODS: A Neutropenic Sepsis Alert Card was created, as a Patient Specific Directive - this allows nurses to administer antibiotics to specific patients without prior medical review. RESULTS: Since the intervention, 301 patients presented with suspected neutropenic sepsis...
2016: Acute Medicine
Zivanit Ergaz, Shmuel Benenson, Noa Ofek-Shlomai, Sinan Abu-Leil, Benjamin Bar-Oz
INTRODUCTION: Early prediction of late onset sepsis is imperative in order to improve survival and reduce long-term complications. Since clinical deterioration is detrimental, empiric antibiotic treatment is initiated once sepsis is suspected. Symptoms that may indicate invasive infection are non-specific. Previous risk scores offered to improve clinical decision-making but provided low predictive values. AIMS: To evaluate the quantitative early alert of software application compared to clinical judgment by the treating physician, and the "gold standard" of positive blood and/or positive cerebrospinal fluid...
January 2016: Harefuah
Naoyuki Matsuda
Sepsis refers to systemic inflammatory response syndrome and organ failure resulting from infection. Inflammatory receptors (e.g., Toll-like receptors and nucleotide oligomerization domain) recognize bacterial components as inflammatory ligands. These are expressed not only in leukocytes but also in major organs and vascular endothelial cells. "Alert cell" is defined as the cell that expresses the inflammatory receptor and intracellular signaling system to produce inflammatory mediators such as inflammatory cytokines, chemokines, nitric oxide, and prostanoids in organs and the vasculature...
2016: Journal of Intensive Care
Anusha Rohit, Biswajit Maiti, Shalini Shenoy, Indrani Karunasagar
BACKGROUND & OBJECTIVES: The difficulties in diagnosis of neonatal sepsis are due to varied clinical presentation, low sensitivity of blood culture which is considered the gold standard and empirical antibiotic usage affecting the outcome of results. Though polymerase chain reaction (PCR) based detection of bacterial 16S rRNA gene has been reported earlier, this does not provide identification of the causative agent. In this study, we used restriction fragment length polymorphism (RFLP) of amplified 16S rRNA gene to identify the organisms involved in neonatal sepsis and compared the findings with blood culture...
January 2016: Indian Journal of Medical Research
Teresa A Williams, Hideo Tohira, Judith Finn, Gavin D Perkins, Kwok M Ho
AIM: To examine whether early warning scores (EWS) can accurately predict critical illness in the prehospital setting and affect patient outcomes. METHODS: We searched bibliographic databases for comparative studies that examined prehospital EWS for patients transported by ambulance in the prehospital setting. The ability of the different EWS, including pre-alert protocols and physiological-based EWS, to predict critical illness (sensitivity, odds ratio [OR], area under receiver operating characteristic [AUROC] curves) and hospital mortality was summarised...
May 2016: Resuscitation
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