Strengthening sepsis care at a tertiary care teaching hospital in New Delhi, India

Abstract

IntroductionFailure of early identification of sepsis in the emergency department (ED) leads to significant delays in antibiotic administration which adversely affects patient outcomes.AimThe primary objective of our Quality Improvement (QI) project was to reduce the door-to-antibiotic time (DTAT) by 30% from the preintervention in patients with suspected sepsis. Secondary objectives were to increase the blood culture collection rate by 30% from preintervention, investigate the predictors of improving DTAT and study the effect of these interventions on 24-hour in-hospital mortality.MethodsThis QI project was conducted in the ED of a tertiary care teaching hospital of North India; the ED receives approximately 400 patients per day. Adult patients with suspected sepsis presenting to our ED were included in the study, between January 2019 and December 2020. The study was divided into three phases; preintervention phase (100 patients), intervention phase (100 patients) and postintervention phase (93 patients). DTAT and blood cultures prior to antibiotic administration was recorded for all patients. Blood culture yield and 24-hour in-hospital mortality were also recorded using standard data templates. Change ideas planned by the Sepsis QI Team were implemented after conducting plan-do-study-act cycles.ResultsThe median DTAT reduced from 155 min in preintervention phase to 78 min in postintervention phase. Drawing of blood cultures prior to antibiotic administration improved by 67%. Application of novel screening tool at triage was found to be an independent predictor of reduced DTAT.ConclusionOur QI project identified the existing lacunae in implementation of the sepsis bundle which were dealt with in a stepwise manner. The sepsis screening tool and on-site training improved care of patients with sepsis. A similar approach can be used to deal with complex quality issues in other high-volume low-resource settings.

The Awareness of Prospective Mathematics Teachers on the Mathematics Curriculum

“…Therefore, the content of the programs is directly related to the quality of education (Bal and Artut, 2013). In this regard, practitioners must organize, plan, and systematically adopt curricula (Malhotra, 2006). In this regard, from the analysis of the responses that the awareness of the preservice teacher who will implement the training programs is high.…”

Current practices of antimicrobial stewardship in the emergency department: A cross-sectional study from a tertiary care centre in North India

“…3 About half of the top 10 causes of ED admissions are due to infection and of the empirical choices of antimicrobial therapy, 30-50% may be inappropriate. 4 In a cross-sectional observational study over 5 weeks in early 2022, we made observations from patients admitted to our ED; out of 73 (of whom, 70% were judged critically ill), an infective etiology was suggested clinically in two thirds and by routine laboratory parameters in one third, but microbiological evidence was found in only four. Three quarters of infections were community-acquired, with pneumonia being the most common (40%).…”

“…3 About half of the top 10 causes of ED admissions are due to infection and of the empirical choices of antimicrobial therapy, 30–50% may be inappropriate. 4…”