RESUMO
WHAT IS ALREADY KNOWN?: The benefits of measuring PCT in the Emergency Department (ED) are not yet fully characterised.PCT is widely used in the intensive care setting to guide antimicrobial prescribing. WHAT THIS ADDS?: Measurement of PCT as a routine in the emergency department for all patients treated for possible sepsis identifies a high-risk cohort. KEY IMPROVEMENT IN PATIENT CARE: A PCT measurement of >0.2ug/L in the Emergency Department identifies a patient at increased risk of deterioration and of in-hospital death. BACKGROUND: Early recognition and management of sepsis in the Emergency Department (ED) is a clinical challenge. Our aim was to determine if measuring the biomarker PCT in patients with suspected sepsis enables the identification of patients at increased risk of deterioration or in-hospital death in the ED setting of a district general hospital in the United Kingdom. METHODS: A prospective observational study was conducted on all patients aged 18 and over presenting to ED fulfilling NICE criteria for moderate to high risk of sepsis admitted to hospital. Patients had a PCT test alongside the sepsis six protocol. PCT was measured using Brahms's chemiluminescent micro particle assay (CMIA) for the quantitative determination of PCT in human serum and plasma on the Abbott Alinity I analytical platform. The cost per test was approximately 13 GBP.The analysis was performed on patients having a PCT in ED over a 7-month period, with in-depth scrutiny of an appropriate subgroup. A high level quality improvement (QI) approach was used in the study. RESULTS: A total of 1242 patients were included in the study. Mean/median age was 67.9/72, (range 18-102). 88.7% of deaths occurred in patients over 65 years of age. 42.4% (n=532) had a PCT level in ED of >0.2 ug/L. This identified a high risk group with a 2.4 fold increase in mortality rate (7.7%:18.2% p value <0.001). The median length of stay (LOS) was 5 (IQR 9) and 8 days (IQR 11) in patients with a first PCT of ≤0.2 ug/L versus >0.2 ug/L respectively. CONCLUSION: An immediate PCT on patients presenting to ED with signs of sepsis in a non-specialised acute trust identifies those patients at an increased risk of deterioration and in hospital death.
RESUMO
Background Since the start of the coronavirus disease 2019 (COVID-19) pandemic, virtual visiting (VV) has become important because of visiting restrictions in hospitals. This project aimed to determine the impact of VV on staff and patients' loved ones (visitors). Methodology VV is defined as high-resolution video communication between admitted COVID-19 patients and their loved ones in the presence of a staff member using a healthcare platform. VV was introduced in a 419-bedded hospital in the UK in April 2020. Qualitative data on the VV experience were collected from relatives and staff via an open feedback email address and reflective practice. Data were entered and analyzed in person by two independent assessors. Grounded theory methodology and thematic analysis were used to draw conclusions. Results Between April 16, 2020 and November 30, 2020, 1,009 visits were delivered. There were 138 feedback responses; 108 (78.3%) from relatives and 30 (21.7%) from staff. The amalgamation of data was resolved into five themes: appreciative factors (129, 93.5%), organizational skills (44, 31.9%), palliative care (38, 27.5%), staff communication (14, 10.1%), and VV process issues (11, 7.9%). A total of 131 (94.9%) responses had positive comments (111 from relatives, 20 from staff); negative comments were greater in the staff cohort (23%) than the relative group (4%). Trends included sub-themes in overwhelming emotions, emotional strain for staff members, and difficult situations. Conclusions VV in hospitals is a new and valuable way to connect patients with loved ones with mostly positive consequences. VV also has risks to mental health and well-being, particularly for healthcare workers facilitating the call.