Improving Sepsis Care Through Systems Change: The Impact of a Medical Emergency Team

Sarani, Babak; Brenner, S; Gabel, Brandon C; Myers, Jennifer S.; Gibson, George A.; J, Phillips; Fuchs, Barry D.

doi:10.1016/s1553-7250(08)34021-5

Cited by 13 publications

(23 citation statements)

References 16 publications

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“…14 Sarani et al demonstrated the time to antibiotic order verification and administration was significantly reduced with the use of an RRT that Groth and Acquisto 3 included a clinical pharmacist. 15 The median time from antimicrobial order to administration was reduced by a median of 103 minutes. The clinical pharmacist was able to approve use of the antimicrobial agents and place a verbal order with immediate verification at the bedside.…”

Section: Discussionmentioning

confidence: 99%

Pharmacists as Members of the Rapid Response Team

Groth

Acquisto

2014

Journal of Pharmacy Practice

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Section: Discussionmentioning

confidence: 99%

Pharmacists as Members of the Rapid Response Team

Groth

Acquisto

2014

Journal of Pharmacy Practice

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“…An operational study by Sarani et al 30 describes an improvement in operational efficiency when a pharmacist is present at the bedside to verify and procure antibiotics for septic patients. The median time from antibiotic order to administration was reduced by 103 minutes when a pharmacist was present versus not present (157 vs 54 minutes; p < 0.01).…”

Section: Pharmacist Involvementmentioning

confidence: 99%

Importance of Pharmacy Involvement in the Treatment of Sepsis

et al. 2017

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Purpose: A review of the impact of pharmacists on appropriate medication selection, timing of administration, and as members of a multidisciplinary sepsis response team. Summary: Early goal-directed therapy (EGDT), currently recommended by the 2013 Surviving Sepsis Campaign guidelines for the management of patients with sepsis, includes the administration of appropriate antibiotics in patients with septic shock within the first hour. Multidisciplinary teams containing pharmacists have been shown to decrease time to antibiotic delivery, time to antibiotic administration, and patient mortality. The pharmacist can act as a drug information resource, expedite the medication verification and procurement process, and offer suggestions on how to better manage the patients. Pharmacists are often consulted for dosing and antibiotic selection recommendations for patients with sepsis, but they can also help increase the appropriateness of antibiotics selected. Additional recommendations and interventions made by pharmacists include fluid management and vasopressor facilitation for the more severe patients. A sepsis management team that included a pharmacist increased the number of patients receiving appropriate antibiotics within the first hour by as much as 22-fold. Another study has demonstrated that intensive care units with a pharmacist are associated with a 4% decrease in sepsis patient mortality compared to those without a pharmacist. Conclusion: Multidisciplinary teams containing pharmacists have been shown to decrease time to administration of antibiotics, increase appropriate selection of medications, and decrease mortality; they may also decrease overall health care costs.

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“…Sarani et al reported on an intervention in which emergency department clinicians could call a "code sepsis" for deteriorating patients thought to have infections. This approach was associated with improvement of patients receiving antibiotics within one hour of diagnosis (from 25% to 85%) 14 . Miano et al developed an antibiotic algorithm to guide their RRT in the delivery of appropriate antibiotics.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

The Epidemiology of Sepsis during Rapid Response Team Reviews in a Teaching Hospital

Cross

Bilgrami

Eastwood³

et al. 2015

Anaesth Intensive Care

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In a three-month retrospective study, we assessed the proportion of rapid response team (RRT) calls associated with systemic inflammatory response syndrome (SIRS) and sepsis. We also documented the site of infection (whether it was community-or hospital-acquired), antibiotic modifications after the call and in-hospital outcomes. Amongst 358 RRT calls, two or more SIRS criteria were present in 277 (77.4%). Amongst the 277 RRT calls with SIRS criteria, 159 (57.4%) fulfilled sepsis criteria in the 24 hours before and 12 hours after the call. There were 118 of 277 (42.6%) calls with SIRS criteria but no evidence of sepsis and 62 of 277 (22.3%) calls associated with both criteria for sepsis as well as an alternative cause for SIRS. Hence, 159 (44.4%) of all 358 RRT calls over the three-month study period fulfilled criteria for sepsis and in 97 (159-62) (27.1%) of the 358 calls, there were criteria for sepsis without other causes for SIRS criteria. The most common sites of infection were respiratory tract (86), abdominal cavity (38), urinary tract (26) and bloodstream (26). Infection was hospital-acquired in 91 (57.2%) and community-acquired in 67 (42.1%) cases, respectively. Patients were on antibiotics in 127 of 159 (79.9%) cases before the RRT call and antibiotics were added or modified in 76 of 159 (47.8%) cases after RRT review. The hospital length-of-stay of patients who received an RRT call associated with sepsis was longer than those who did not (16.0 [8.0 to 28.5] versus 10 [6.0 to 18.0]; P=0.002).

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Improving Sepsis Care Through Systems Change: The Impact of a Medical Emergency Team

Cited by 13 publications

References 16 publications

Pharmacists as Members of the Rapid Response Team

Pharmacists as Members of the Rapid Response Team

Importance of Pharmacy Involvement in the Treatment of Sepsis

The Epidemiology of Sepsis during Rapid Response Team Reviews in a Teaching Hospital

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