ABSTRACT
INTRODUCTION: Emergency departments (EDs) play an important role in the early identification and management of sepsis. Little is known about local EDs' processes of care for sepsis, adoption of international recommendations, and the impact of the new Sepsis-3 definitions. METHODS: Structured telephone interviews based on the United Kingdom Sepsis Trust 'Exemplar Standards for the Emergency Management of Sepsis' were conducted from January to August 2017 with nominated representatives of all responding public hospital EDs in Hong Kong, followed by a review of hospital/departmental sepsis guidelines by the investigators. RESULTS: Sixteen of the 18 public EDs in Hong Kong participated in the study. Among various time-critical medical emergencies such as major trauma, sepsis was perceived by the interviewees to be the leading cause of in-hospital mortality and the second most important preventable cause of death. However, only seven EDs reported having departmental guidelines on sepsis care, with four adopting the Quick Sequential Organ Failure Assessment score or its modified versions. All responding EDs reported that antibiotics were stocked within their departments, and all EDs with sepsis guidelines mandated early intravenous antibiotic administration within 1 to 2 hours of detection. Reported major barriers to optimal sepsis care included lack of knowledge and experience, nursing human resources shortages, and difficulty identifying patients with sepsis in the ED setting. CONCLUSION: There are considerable variations in sepsis care among EDs in Hong Kong. More training, resources, and research efforts should be directed to early ED sepsis care, to improve patient outcomes.
Subject(s)
Emergency Service, Hospital/statistics & numerical data , Practice Guidelines as Topic , Sepsis/therapy , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/supply & distribution , Cross-Sectional Studies , Emergency Service, Hospital/standards , Hong Kong , Hospital Mortality , Hospitals, Public/standards , Hospitals, Public/statistics & numerical data , Humans , Interviews as Topic , Organ Dysfunction Scores , Sepsis/diagnosis , Sepsis/mortalityABSTRACT
Human services agencies are closer than ever to fulfillment of their authoritative role. A critical step is transformation of the Reporting System to a Management Information System. This creates the information structure and mind set necessary to generate new, data-based ideas. There are too many obstacles to traditional MIS development approaches in agencies, however. New strategies such as selective use of end-user technology and prototyping can provide methods that overcome these obstacles.