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STAG Sepsis Audit Pilot Study 2008

STAG Sepsis Audit Pilot Study 2008. Phase 1: Resuscitation Room Casemix Phase 2: Physiological Derangement Phase 3: Physiological Derangement (GP referrals). Audit Questions. How should we design the audit? How do we identify our patient group? Where can we find the information we need?

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STAG Sepsis Audit Pilot Study 2008

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  1. STAG Sepsis AuditPilot Study2008 Phase 1: Resuscitation Room Casemix Phase 2: Physiological Derangement Phase 3: Physiological Derangement (GP referrals)

  2. Audit Questions • How should we design the audit? • How do we identify our patient group? • Where can we find the information we need? • Where are the patients managed? • What is the typical patient journey?

  3. Definitions • Systemic Inflammatory Response Syndrome (SIRS) is diagnosed when two or more of the following are present: • Temperature greater than 38°C or less than 36°C • Heart rate greater than 90 beats per minute (bpm) • Respiratory rate greater than 20 breaths per minute or PaCO2 less than 32 mmHg/4.26 kPa • White blood cell count greater than 12,000/µL or 12.0*109/L, less than 4000/µL or 4.0*109/L, or 10% immature (band) forms*. • Sepsis is diagnosed where SIRS is present and the patient is suffering from an infection. *Neutrophil granulocytes lacking nuclear lobes (a high proportion of such cells often indicates a systemic response to infection).

  4. Phase 1: Resuscitation Room Casemix Target group: Patients seen in resuscitation room during ED stay • 19 Emergency Departments across Scotland • 28 days between 3rdMarch 2008 to 30th March 2008 • A total of 77,059 ED presentations • 3,609 (4.7%) managed in Resus (average 143 patients/day) How many of our patients were managed in the Resuscitation Room?

  5. The patient journey (Resuscitation Room)* • 49% of Resuscitation Room patients had evidence of sepsis/SIRS • 32% of sepsis/SIRS patients were given IV antibiotics in the ED • 16% of sepsis/SIRS patients went directly to ICU/HDU • 56% of sepsis/SIRS patients went directly to a ward • Median inpatient days for sepsis/SIRS Resus patients was 4 days • Median inpatient days for non-sepsis/SIRS Resus patients was 4 days • 18% of the sepsis/SIRS Resus patients died • 9% of the non-sepsis/SIRS Resus patients died * Only seven EDs had sufficient physiological information available (n=1511). All of the above information relates solely to those seven EDs.

  6. Phase 2: Physiological Derangement Target group: ED patients with sepsis/SIRS • 19 Emergency Departments • 14 days between 11.06.08 and 24.07.08 • 40,012 ED presentations • 1,591 (4.04%) with suspected sepsis/SIRS (average 115 patients/day) How many ED patients had sepsis/SIRS?

  7. Phase 3: Physiological Derangement (GP referral) Target group: Patients with sepsis/SIRS referred to ED/admissions unit by GPs • Emergency Departments and Admission Units in 11 hospitals • 7 days between 31.08.08 and 26.09.08 • 10,797 presentations • 165 (1.53%) with suspected sepsis/SIRS (average 24 patients/day) How many patients referred to EDs/Admissions Units by GPs had sepsis/SIRS? Note: Phases 2 and 3 data are combined hereafter (n=1,756)

  8. The patient journey* • 64% of suspected sepsis/SIRS patients arrived by ambulance • 21% suspected sepsis/SIRS were referred to hospital by their GP • 4% of sepsis/SIRS patients were sent to ICU or HDU from ED/Admissions Unit • 82% of sepsis/SIRS patients went to a ward from ED/Admissions Unit • Median stay for sepsis/SIRS patients admitted via ED was 5 days • Median stay for sepsis/SIRS patients admitted via the Admissions Unit was 7 days • Outcome up to 28 days was recorded: 9% of sepsis/SIRS patients admitted via ED died 17% of sepsis/SIRS patients admitted via Admissions Units died *Analysis utilises combined phase 2 and 3 data (n=1,756)

  9. Who is included in the patient group?* • Evidence of sepsis/SIRS was observed among 94% (1655) of patients. The remaining 101 were included because sepsis/infection was suspected and there was no sufficient basis for exclusion. • 32% of patients with sepsis/SIRS were given IV antibiotics in the ED or admissions unit. *Analysis utilises combined phase 2 and 3 data (n=1,756)

  10. What information can we get?* EDs/admission units** (n=28) with valid physiological data for 80% patients: • Temperature, HR, systolic and diastolic BP 28/28 • Respiratory rate and O2 saturation 27/28 • WBC 20/28 • GCS/AVPU scores 19/28 • SEWS etc. chart scores 8/28 • BM measurements 1/28 • Lactate measurements 0/28 *Analysis utilises combined phase 2 and 3 data (n=1,756) **Physiological information was gathered from SAS notes, ED notes, Observation charts, computerised laboratory results and casenotes.

  11. STAG Sepsis Audit • We will identify every eligible patient from 01.03.09 to 31.05.09 admitted via the ED or Admissions Units • We will check ICU and HDU for patients who were admitted to a ward and then deteriorated • We will check all in-hospital deaths • We will then collect all the data we need from patients’ casenotes How you can help: Can you indicate if you think a patient has sepsis/SIRS? Can you record the first set of observations on the ED computer system (where applicable) in order to assist with case identification and follow-up? Can your record their other observations (as per your STAG Sepsis card)? Can you document the administration of antibiotics? Thanks!

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