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Prehospital sepsis alert notification decreases time to initiation of CMS sepsis core measures

Published:September 22, 2018DOI:https://doi.org/10.1016/j.ajem.2018.09.034

      Abstract

      Objective

      To determine if prehospital identification of sepsis will affect time to Centers for Medicare and Medicaid services (CMS) sepsis core measures and improve clinical outcomes.

      Methods

      We conducted a retrospective cohort study among septic patients who were identified as “sepsis alerts” in the emergency department (ED). Metrics including time from ED registration to fluid resuscitation, blood cultures, serum lactate draws, and antibiotics administration were compared between those who had pre-arrival notification by EMS versus those that did not. Additionally, outcomes such as mortality and intensive care unit (ICU) admission were recorded.

      Results

      Of the 272 total patients, 162 had pre-arrival notification (prehospital sepsis alerts) and 110 did not. The prehospital sepsis alert group had significantly lower times to intravenous fluid administration (6 min 95%CI 4–9 min vs 41 min 95%CI 24–58 min, p < 0.001), blood cultures drawn (12 min 95%CI 10–14 min vs 34 min 95%CI 20–48 min, p = 0.003), lactate levels drawn (12 min 95%CI 10–15 min vs 34 min 95%CI 20–49 min, p = 0.003), and administration of antibiotics (33 min 95%CI 26–40 min vs 61 min 95%CI 44–78 min, p = 0.004). Patients with prehospital sepsis alerts also had a higher admission rate (100% vs 95%, p = 0.006), and a lower ICU admission rate (33% vs 52%, p = 0.003). There was no difference in mortality (11% vs 14%, p = 0.565) between groups.

      Conclusions

      Prehospital sepsis alert notification may decrease time to specific metrics shown to improve outcomes in sepsis.

      Keywords

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