Early identification of sepsis in hospital inpatients by ward nurses increases 30-day survival

Abstract

BackgroundSystemic inflammatory response syndrome (SIRS) and sepsis are now frequently identified by observations of vital signs and detection of organ failure during triage in the emergency room. However, there is less focus on the effect on patient outcome with better observation and treatment at the ward level.MethodsThis was a before-and-after intervention study in one emergency and community hospital within the Mid-Norway Sepsis Study catchment area. All patients with confirmed bloodstream infection have been prospectively registered continuously since 1994. Severity of sepsis, observation frequency of vital signs, treatment data, length of stay (LOS) in high dependency and intensive care units, and mortality were retrospectively registered from the patients’ medical journals.ResultsThe post-intervention group (n = 409) were observed better and had higher odds of surviving 30 days (OR 2.7, 95 % CI 1.6, 4.6), lower probability of developing severe organ failure (0.7, 95 % CI 0.4, 0.9), and on average, 3.7 days (95 % CI 1.5, 5.9 days) shorter LOS than the pre-intervention group (n = 472).ConclusionsIn a cohort with stable mortality rates, early sepsis recognition by ward nurses may have reduced progression of disease and improved survival for patients in hospital with sepsis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1423-1) contains supplementary material, which is available to authorized users.

Promoting early identification of sepsis in hospitalized patients with nurse-led protocols

“…A study from Norway targeted early identification of in-hospital sepsis by ward nurses [8]. As part of the Mid-Norway Sepsis Study, the study assessed the impact of a bundle intervention consisting of a flow chart for sepsis identification and physician notification and a clinical tool for triage of patients exhibiting signs of sepsis and organ failure.…”

“…In comparison to a pre-intervention group of 472 patients with confirmed blood stream infection during a 2-year period, 409 patients with confirmed blood stream infection in a 2-year post-intervention period were found to have higher odds of surviving 30 days (odds ratio (OR) 2.7, 95% confidence interval (CI) 1.6–4.6), lower probability of developing severe organ failure (0.7, 95% CI 0.4–0.9), and, on average, 3.7 days (95% CI 1.5–5.9 days) shorter length of stay [8]. …”

Erfaringer med mobile intensivsykepleiere (MIS)

“…In a number of European countries and countries such as the USA and Australia, it is the METs and RRTs that handle such patients. When nurses identify symptoms of deterioration at an early stage, such as sepsis symptoms, earlier studies have shown an increase in the 30-day survival rate (12). A previous study by OUH, Rikshospitalet found that the nurses were satisfied with the MICN service, but did not provide reasons for use or descriptions of measures taken by the MICNs (5).…”

Proinflammatory cytokine profile in children with neonatal sepsis

“…Резуль-тат этих процессов -развитие синдрома системного воспалительного ответа, являющегося одной из «со-ставляющих» диагноза «сепсис» [11,12]. Установле-но, что ранняя диагностика сепсиса по показателям синдрома системного воспалительного ответа и со-ответственно своевременно предоставленная помощь снижают риск развития септического шока и уве-личиваеют выживаемость пациентов [13]. Однако до сих пор не найден тот «идеальный» маркер сепси-са, который отличался бы одновременно и высокой чувствительностью, и специфичностью.…”