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

Abstract

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).

Sepsis and septic shock

“…One member of the team would be clearly identified as the leader to direct and coordinate the overall management process. The sepsis team should be available at all times 126–128 .…”

Recognizing and managing sepsis: what needs to be done?

“…These populations often have concurrent medical or surgical conditions that confound the diagnosis, making early recognition difficult. The widespread introduction of rapid response systems has led to the early identification and the initiation of early intervention to patients within the hospital system [ 24 ], many of whom will deteriorate secondary to sepsis. One other area that offers ongoing promise with regards to the early identification of patients with sepsis is the use of biomarkers.…”

Development and Validation of an Automated Sepsis Risk Assessment System

“…Authors of review articles have shown that RRT decreased the number of cardiac arrests and severe adverse events in the non‐ICU units (Solomon, Corwin, Barclay, Quddusi, & Dannenberg, ). In particular, 20–50% of patients for whom the RRT took action showed signs of sepsis (Cross et al, ; Mullins & Psirides, ; Sebat et al, ). Thus, we believe that the RRT in the study hospital contributed greatly to prompt resuscitation of non‐ICU patients who developed sepsis and could have influenced the increased proportion of patients diagnosed with sepsis in the general units and the reduced proportions of sepsis patients with a history of ICU admission as the study progressed.…”