Cross-sectional study on emergency department management of sepsis

Hung, Kevin Kei Ching; Lam, R Pk; Lo, R Sl; Tenney, Justin W; Yang, Marc Li Chuan; Tai, Marcus C K; Graham, Colin A.

doi:10.12809/hkmj177149

Cited by 4 publications

(7 citation statements)

References 28 publications

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“… 10 Lack of knowledge and training, staff nursing, and difficulties in identifying sepsis patients in the Emergency department (ED) are the main obstacles in sepsis management. 11 A good level of understanding, attitude, and practice regarding sepsis protocols is therefore necessary for the management of this condition to be improved. 12 The prompt and efficient treatment of sepsis accompanied by good practices and availability of equipment will aid in preventing the development of septic shock, which can lead to organ dysfunction and is associated with a high mortality rate.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Knowledge, Attitudes, Practices and Barriers Regarding Sepsis and Sepsis Management Among Emergency Nurses and Physicians in Palestine: A Cross-Sectional Analysis

Salameh

Aboamash²

2022

INQUIRY

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Sepsis is a widespread problem that can create clinical and economic difficulties. This study aimed to determine the knowledge, attitudes, practices, and barriers related to the sepsis and sepsis management among emergency nurses and physicians. Data was collected using a self-questionnaire completed by the participating nurses and physicians (n = 243), with a 61% response rate. The study found that both emergency nurses and physicians had poor-to-moderate levels of sepsis knowledge, with emergency physicians having better attitudes regarding sepsis and sepsis management than emergency nurses. However, moderate knowledge levels of sepsis practice and management were shown among both nurses and physicians. It is evident that for emergency nurses and physicians, the biggest barrier to providing quality care to patients with sepsis is the lack of monitoring equipment. Both nurses and physicians need consistent sepsis management information provided by continual education programs. Development of an approved protocol can improve nurses’ knowledge, attitudes, and practices.

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Section: Introductionmentioning

confidence: 99%

Predictors of Knowledge, Attitudes, Practices and Barriers Regarding Sepsis and Sepsis Management Among Emergency Nurses and Physicians in Palestine: A Cross-Sectional Analysis

Salameh

Aboamash²

2022

INQUIRY

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“…After obtaining written consent, the ED staff participants will be interviewed in small focus groups for up to 90 min with a semistructured interview guide (online supplemental file 2), which is developed based on TDF and our previous study results 13. The focus group interviews will explore the barriers to and facilitators of implementing the NEWS-1 care in local ED settings, the overall experience of the staff involved and ‘how’ and ‘why’ the implementation works or does not work.…”

Section: Methods and Analysismentioning

confidence: 99%

Early sepsis care with the National Early Warning Score 2-guided Sepsis Hour-1 Bundle in the emergency department: hybrid type 1 effectiveness-implementation pilot stepped wedge randomised controlled trial (NEWS-1 TRIPS) protocol

Lam,

Hung,

Lui

et al. 2024

BMJ Open

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IntroductionEarly sepsis treatment in the emergency department (ED) is crucial to improve patient survival. Despite international promulgation, the uptake of the Surviving Sepsis Campaign (SSC) Hour-1 Bundle (lactate measurement, blood culture, broad-spectrum antibiotics, 30 mL/kg crystalloid for hypotension/lactate ≥4 mmol/L and vasopressors for hypotension during/after fluid resuscitation within 1 hour of sepsis recognition) is low across healthcare settings. Delays in sepsis recognition and a lack of high-quality evidence hinder its implementation. We propose a novel sepsis care model (National Early Warning Score, NEWS-1 care), in which the SSC Hour-1 Bundle is triggered objectively by a high NEWS-2 (≥5). This study aims to determine the feasibility of a full-scale type 1 hybrid effectiveness-implementation trial on the NEWS-1 care in multiple EDs.Methods and analysisWe will conduct a pilot type 1 hybrid trial and prospectively recruit 200 patients from 4 public EDs in Hong Kong cluster randomised in a stepped wedge design over 10 months. All study sites will start with an initial period of standard care and switch in random order at 2-month intervals to the NEWS-1 care unidirectionally. The implementation evaluation will employ mixed methods guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, which includes qualitative and quantitative data from focus group interviews, staff survey and clinical record reviews. We will analyse the 14 feasibility outcomes as progression criteria to a full-scale trial, including trial acceptability to patients and staff, patient and staff recruitment rates, accuracy of sepsis screening, protocol adherence, accessibility to follow-up data, safety and preliminary clinical impacts of the NEWS1 care, using descriptive statistics.Ethics and disseminationThe institutional review boards of all study sites approved this study. This study will establish the feasibility of a full-scale hybrid trial. We will disseminate the findings through peer-reviewed publications, conference presentations and educational activities.Trial registration numberNCT05731349.

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“…Central venous catheter (CVC) insertion is an essential skill for managing critically ill, sepsis and trauma patients commonly encountered in the emergency department. [1][2][3][4][5][6] The internal jugular, femoral and subclavian/axillary vein (SV) are often used for cannulation. Centers for Disease Control and Prevention (CDC) guidelines recommended placing subclavian lines in adult patients as it is associated with fewer catheter-related infections.…”

Section: Background and Rationalementioning

confidence: 99%

“…Central venous catheter (CVC) insertion is an essential skill for managing critically ill, sepsis and trauma patients commonly encountered in the emergency department 1–6 . The internal jugular, femoral and subclavian/axillary vein (SV) are often used for cannulation.…”

Section: Introductionmentioning

confidence: 99%

Effect of shoulder positioning on ultrasonic visualisation of the subclavian vein in healthy adults: A prospective observational study

Leung

Wong

Pak

et al. 2021

Hong Kong Journal of Emergency Medicine

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Introduction: Ultrasound guidance is commonly used during central venous cannulation. Subclavian vein is a commonly chosen site, but previous studies found varying results in the ideal positioning of the shoulder for subclavian vein cannulation. The objective of this study is to determine which shoulder position results in the greatest cross-sectional area of the right subclavian vein for cannulation. Methods: In this prospective observational study, ultrasound was performed on healthy adult volunteers to visualise the right subclavian vein in three different shoulder positions: neutral, abduction and retraction. A blinded independent investigator measured the cross-sectional areas by computer software using planimetry method. Statistical analysis was performed by one-way repeated measures analysis of variance. Results: Forty-four adults participated in the study. The mean cross-sectional area of the right subclavian vein in shoulder neutral, abduction and retraction positions were 1.05 ± 0.33 cm2, 1.01 ± 0.31 cm2 and 0.82 ± 0.28 cm2, respectively. When compared to shoulder retraction, the cross-sectional areas were significantly increased in shoulder neutral ( P < 0.01) and abduction ( P < 0.01) positions. There was no significant difference between shoulder neutral and abduction position ( P = 0.71). Conclusion: Positioning the shoulder in neutral or abduction results in the greatest cross-sectional area of the right subclavian vein and may be more ideal for ultrasound guided cannulation.

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Cross-sectional study on emergency department management of sepsis

Cited by 4 publications

References 28 publications

Predictors of Knowledge, Attitudes, Practices and Barriers Regarding Sepsis and Sepsis Management Among Emergency Nurses and Physicians in Palestine: A Cross-Sectional Analysis

Predictors of Knowledge, Attitudes, Practices and Barriers Regarding Sepsis and Sepsis Management Among Emergency Nurses and Physicians in Palestine: A Cross-Sectional Analysis

Early sepsis care with the National Early Warning Score 2-guided Sepsis Hour-1 Bundle in the emergency department: hybrid type 1 effectiveness-implementation pilot stepped wedge randomised controlled trial (NEWS-1 TRIPS) protocol

Effect of shoulder positioning on ultrasonic visualisation of the subclavian vein in healthy adults: A prospective observational study

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