[Implementation of an automatic alarms system for early detection of patients with severe sepsis]. / Implementación de un sistema de alarmas automático para la detección precoz de los pacientes con sepsis grave.

OBJECTIVE: The objective of this study was to assess the usefulness of a software tool integrated into the medical electronic history at the time of emergency triage. The aim was the early detection of patients with severe sepsis, and the potential impact of this software tool on reducing the mortality rate in patients treated. METHOD: The study consisted of two comparative samples. Patient selection was performed retrospectively into two groups using ICD-9 codes from the hospital and emergency department discharge reports. The codes were 038.9, 995.9 and 995.92 for sepsis, and 785.52 for severe sepsis and septic shock. The sample called «alarms¼ consisted of patients studied after implementing the sepsis alarm system in the Emergency Department computer system. There were two types of alarms, a serious one and an alert one depending on the on vital signs defined. The historical sample called «no alarms¼ consisted of patients seen in the Emergency Department during the year before the introduction of the alarm system. RESULTS: The compliance rate of the sepsis treatment package was higher in the «alarms¼ sample, compared to the sample without alarms, with blood cultures, 96.3% versus 80.9% (P<.001), antibiotic treatment in less than one hour, 62.9% vs. 39.3% (P<.001), determination of lactic acid, 91.4% vs. 77.9% (P<.001), and applying appropriate volume, 57.7% vs 54.3% (P=.052), respectively. The hospital mortality was reduced in absolute terms from 25% in the sample without alarms to 13.6% in the sample with alarms. Survival at 30 days was higher in the sample with alarms (Log Rank=.004). CONCLUSIONS: There were no studies that evaluated the effectiveness of an alarm system in our literature search. An electronic identification system for patients with sepsis allows acting earlier, better compliance with basic measures, and a reduction in hospital stay and mortality.

Implementación de un sistema de alarmas automático para la detección precoz de los pacientes con sepsis grave / Implementation of an automatic alarms system for early detection of patients with severe sepsis

No disponible

Implementación de un sistema de alarmas automático para la detección precoz de los pacientes con sepsis grave / Implementation of an automatic alarms system for early detection of patients with severe sepsis

OBJETIVO: Valorar la utilidad de una herramienta informática integrada en el programa de historia clínica de urgencias en el momento del triaje, para detectar de forma precoz pacientes con sepsis grave, y su posible repercusión en reducir las cifras de mortalidad en los pacientes atendidos. MÉTODO: El estudio constaba de 2 muestras comparativas. La selección de pacientes se realizó de forma retrospectiva en los 2 grupos utilizando los códigos CIE-9 al alta de urgencias y hospitalaria 038.9, 995.91 para la sepsis, 995.92 para sepsis grave y 785.52 para shock séptico. La muestra denominada «alarmas» constaba de los pacientes estudiados tras implantar el sistema de alarmas de sepsis en el sistema informático de urgencias. Se definieron 2 tipos de alarmas, una de gravedad y otra de alerta en función de las constantes vitales alteradas. La muestra histórica, denominada «sin alarmas», constaba de pacientes atendidos en el servicio de urgencias durante el año previo a la implantación del sistema de alarmas. RESULTADOS: El porcentaje de cumplimiento del paquete de tratamiento de la sepsis fue mayor en la muestra de alarmas, comparativamente con la muestra sin alarmas, respectivamente, para los hemocultivos 96,3% frente a 80,9% (p < 0,001), antibiótico menor a 1 h 62,9% frente a 39,3% (p < 0,001), determinación de ácido láctico 91,4% frente a 77,9% (p < 0,001) y la aplicación de volumen adecuado 57,7% frente a 54,3% (p = 0,54). La mortalidad durante el ingreso se redujo en términos absolutos del 25% de la muestra sin alarmas al 13,6% en la muestra con alarmas. La supervivencia a los 30 días fue mayor en la muestra de alarmas (log rank = 0,004). CONCLUSIONES: Un sistema electrónico de identificación de pacientes con sepsis permite una mayor precocidad en la actuación, un cumplimiento mejor de las medidas básicas y por tanto una disminución de la estancia y la mortalidad

OBJECTIVE: The objective of this study was to assess the usefulness of a software tool integrated into the medical electronic history at the time of emergency triage. The aim was the early detection of patients with severe sepsis, and the potential impact of this software tool on reducing the mortality rate in patients treated. METHOD: The study consisted of two comparative samples. Patient selection was performed retrospectively into two groups using ICD-9 codes from the hospital and emergency department discharge reports. The codes were 038.9, 995.9 and 995.92 for sepsis, and 785.52 for severe sepsis and septic shock. The sample called «alarms» consisted of patients studied after implementing the sepsis alarm system in the Emergency Department computer system. There were two types of alarms, a serious one and an alert one depending on the on vital signs defined. The historical sample called «no alarms» consisted of patients seen in the Emergency Department during the year before the introduction of the alarm system. RESULTS: The compliance rate of the sepsis treatment package was higher in the «alarms» sample, compared to the sample without alarms, with blood cultures, 96.3% versus 80.9% (P < .001), antibiotic treatment in less than one hour, 62.9% vs. 39.3% (P < .001), determination of lactic acid, 91.4% vs. 77.9% (P < .001), and applying appropriate volume, 57.7% vs 54.3% (P = .052), respectively. The hospital mortality was reduced in absolute terms from 25% in the sample without alarms to 13.6% in the sample with alarms. Survival at 30 days was higher in the sample with alarms (Log Rank = .004). CONCLUSIONS: There were no studies that evaluated the effectiveness of an alarm system in our literature search. An electronic identification system for patients with sepsis allows acting earlier, better compliance with basic measures, and a reduction in hospital stay and mortality