Implementing a quick Sequential (Sepsis-Related) Organ Failure Assessment sepsis screening tool: an interrupted times series study

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Alberto, L
Aitken, LM
Walker, RM
Pálizas, F
Marshall, AP
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2020
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Abstract

OBJECTIVE: The aim of this study was to evaluate the outcomes of implementing a sepsis screening (SS) tool based on the quick Sequential [Sepsis-Related] Organ Failure Assessment (qSOFA) and the presence of confirmed/suspected infection. The implementation of the 6-hour (6-h) bundle was also evaluated. DESIGN: Interrupted times series with prospective data collection. SETTING: Five hospital wards in a developing nation, Argentina. PARTICIPANTS: 1151 patients (≥18 years) recruited within 24-48 hours of hospital admission. INTERVENTION: The qSOFA-based SS tool and the 6-h bundle. MAIN OUTCOME MEASURES: The primary outcome was the timing of implementation of the first 6-h bundle element. Secondary outcomes were related to the adherence to the screening procedures. RESULTS: Of 1151 patients, 145 (12.6%) met the qSOFA-based SS tool criteria, among them intervention (39/64) patients received the first 6-h bundle element earlier (median 8 hours; 95% CI: 0.1-16) than baseline (48/81) patients (median 22 hours; 95% CI: 3-41); these times, however, did not differ significantly (p = 0.525). Overall, 47 (4.1%) patients had sepsis; intervention patients (18/25) received the first 6-h bundle element sooner (median 5 hours; 95% CI: 4-6) than baseline patients (15/22) did (median 12 hours; 95% CI: 0-33), however times were not significantly different (p = 0.470). While intervention patients were screened regularly, only one-third of patients that required sepsis alerts had them activated. CONCLUSION: The implementation of the qSOFA-based SS tool resulted in early, but not significantly improved, provision of 6-h bundle care. Screening procedures were regularly conducted, but sepsis alerts rarely activated. Further research is needed to better understand implementation of sepsis care in developing settings.

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International Journal for Quality in Health Care
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© 2020 Oxford University Press. This is a pre-copy-editing, author-produced PDF of an article accepted for publication in International Journal for Quality in Health Care following peer review. The definitive publisher-authenticated version Implementing a quick Sequential (Sepsis-Related) Organ Failure Assessment sepsis screening tool: an interrupted times series study, International Journal for Quality in Health Care, 2020 is available online at: https://doi.org/10.1093/intqhc/mzaa059.
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Biomedical and clinical sciences
Psychology
Applied economics
Health services and systems
Policy and administration
6-h bundle
developing nation
hospital ward
implementation
qSOFA
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Alberto, L; Aitken, LM; Walker, R; Pálizas, F; Marshall, AP, Implementing a quick Sequential (Sepsis-Related) Organ Failure Assessment sepsis screening tool: an interrupted times series study, International Journal for Quality in Health Care, 2020
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