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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Article Info
Publication History
Published online: September 22, 2018
Accepted:
September 22,
2018
Received in revised form:
September 20,
2018
Received:
August 6,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
