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Poeze, Martijn; Ramsay, Graham; Gerlach, Herwig; Rubulotta, Francesca; Levy, Mitchel

doi:10.1186/cc2959

Cited by 158 publications

(51 citation statements)

References 12 publications

(13 reference statements)

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“…Third, we found that junior doctors self-reported a need for additional training in the areas of both clinical review of infected patients, and principles of prescribing. This links to established patient safety agendas, and clearly establishes a need for education on sepsis resuscitation [27], and therapeutic drug monitoring [28, 29] respectively.…”

Section: Discussionmentioning

confidence: 99%

A needs assessment study for optimising prescribing practice in secondary care junior doctors: the Antibiotic Prescribing Education among Doctors (APED)

et al. 2016

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BackgroundAppropriate antimicrobial prescribing is essential for patient care, yet up to half of antimicrobial prescriptions written in the UK are sub-optimal. Improving prescriber education has recently been promoted as a mechanism to optimise antimicrobial use, but identification of key learning objectives to facilitate this is so far lacking. Using qualitative methods we investigated junior doctor knowledge, attitudes, and behaviours around antimicrobial prescribing to identify key areas to address in future educational programmes.MethodsA cross-sectional survey of qualified doctors in training in West London was undertaken exploring antimicrobial prescribing practices and educational needs.ResultsAmong 140 junior doctors from 5 London hospitals, a third (34 %) reported prescribing primarily unsupervised, and two thirds (67 %) reported difficulties obtaining prescribing support outside of hours. 20 % stated not feeling confident in writing an antimicrobial prescription, but confidence was increased through having confirmatory diagnostic results (24) and obtaining advice from a senior doctor (26 %); whether this senior was from their own specialty, or an infection-specialist, varied significantly (p < 0.01) by experience. Only a small percentage (5–13 %; depending on number of years post-qualification) of participants stated their previous antimicrobial education was effective. 60 % of those in their first year post qualification reported wanting further education in antimicrobial prescribing, rising to 74 % among more experienced junior doctors. Specific areas of educational need identified were (i) principles of antimicrobial prescribing, (ii) diagnosis of infections, (iii) clinical review of patients with infections, (iv) prescribing in the context of antimicrobial resistance, and (v) laboratory testing and test results.ConclusionsA significant proportion of junior doctors report lone prescribing of antimicrobials in the context of low self-perceived confidence and knowledge in this field, and frequent difficulty in accessing help when necessary. Innovative training, targeting five specific areas identified through this needs assessment, is urgently needed by junior doctors practising in secondary care.

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Section: Discussionmentioning

confidence: 99%

A needs assessment study for optimising prescribing practice in secondary care junior doctors: the Antibiotic Prescribing Education among Doctors (APED)

et al. 2016

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“…(16, 17) Twelve items were reviewed by a focus group of three EMS directors,one emergency medicine physician, ten intensivists, and two senior paramedics. This group was chosen because they would not otherwise be included in the main study population, but their medical practices and training programs commonly involve emergency care of patients with sepsis.…”

Section: Methodsmentioning

confidence: 99%

Understanding of Sepsis among Emergency Medical Services: A Survey Study

Seymour

Carlbom

Engelberg

et al. 2012

The Journal of Emergency Medicine

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Background Emergency medical services (EMS) personnel commonly encounter sepsis, yet little is known about their understanding of sepsis. Study Objectives To determine the awareness, knowledge, current practice, and attitudes about sepsis among EMS personnel. Methods We performed an anonymous, multi-agency, online survey of emergency medical technicians (EMTs), firefighter-emergency medical technicians (FF-EMTs), and paramedics in a metropolitan, 2-tier EMS system. We compared responses according to the level of EMS training, and used multivariable logistic regression to determine the odds of correctly identifying the definition of sepsis, independent of demographic and professional factors. Results Overall response rate of study participants was 57% (786/1390), and greatest among EMTs (78%; 276/350). A total of 761 respondents (96%) had heard of the term sepsis. EMTs and FF-EMTs were at significantly reduced odds of correctly defining sepsis compared to paramedics, independent of age, sex, and years of experience (EMTs, OR=0.44, 95%CI:0.3,0.8; FF-EMTs, OR=0.32, 95%CI:0.2,0.6,). Overall, knowledge of the clinical signs and symptoms and recommended treatments for sepsis was typically greater than 75%, though best among paramedics than EMTs or FF-EMTs (p<0.01). The majority of respondents believed sepsis is not recognized by EMS “some” or “a lot” of the time (76%, 596/786). Conclusions EMS personnel demonstrated an overall sound awarenessof sepsis. Knowledge of sepsis was less among firefighter-EMTs and EMTs compared to paramedics. These results suggest that paramedics could be integrated into strategies of early identification and treatment of sepsis while EMTs may benefit from focused education and training.

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“…Severely septic patients generally require intensive care unit management, and indeed approximately 20% of all ICU admissions are complicated by infection 3 . Sepsis is defined as the systemic inflammatory response (SIRS) to infection 4 , but in a recent worldwide survey of physicians, the ACCP definition was not recognized or utilized by the majority of respondents 5 . The lack of consensus among practicing physicians is a barrier to early recognition of sepsis in a complex ICU environment.…”

Section: Introductionmentioning

confidence: 99%

Randomized trial of automated, electronic monitoring to facilitate early detection of sepsis in the intensive care unit*

Hooper

Weavind

Wheeler

et al. 2012

Critical Care Medicine

107

117

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Objective To determine whether automated identification with physician notification of the systemic inflammatory response syndrome in medical intensive care unit (MICU) patients expedites early administration of new antibiotics or improvement of other patient outcomes in patients with sepsis. Design A prospective, randomized, controlled, single-center study. Setting MICU of an academic, tertiary-care medical center. Patients 442 consecutive patients admitted over a 4 month period who met modified SIRS criteria in a MICU. Intervention Patients were randomized to monitoring by an electronic “Listening Application” to detect modified (SIRS) criteria vs. usual care. The Listening Application notified physicians in real-time when modified SIRS criteria were detected, but did not provide management recommendations. Measurements and Main Results The median time to new antibiotics was similar between the intervention and usual care groups whether comparing among all patients (6.0h vs 6.1h, p=0.95), patients with sepsis (5.3h vs. 5.1h; p=0.90), patients on antibiotics at enrollment (5.2h vs. 7.0h, p= 0.27), or patients not on antibiotics at enrollment (5.2h vs. 5.1h, p= 0.85). The amount of fluid administered following detection of modified SIRS criteria was similar between groups whether comparing all patients or only patients hypotensive at enrollment. Other clinical outcomes including ICU length of stay, hospital length of stay, and mortality were not shown to be different between patients in the intervention and control groups. Conclusions Real-time alerts of modified SIRS criteria to physicians in one tertiary care MICU were feasible and safe but did not influence measured therapeutic interventions for sepsis or significantly alter clinical outcomes.

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Untitled

Cited by 158 publications

References 12 publications

A needs assessment study for optimising prescribing practice in secondary care junior doctors: the Antibiotic Prescribing Education among Doctors (APED)

A needs assessment study for optimising prescribing practice in secondary care junior doctors: the Antibiotic Prescribing Education among Doctors (APED)

Understanding of Sepsis among Emergency Medical Services: A Survey Study

Randomized trial of automated, electronic monitoring to facilitate early detection of sepsis in the intensive care unit*

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