دورية أكاديمية
أعرض في EDS

Effect of a tailored sepsis treatment protocol on patient outcomes in the Tikur Anbessa Specialized Hospital, Ethiopia: results of an interrupted time series analysis.

التفاصيل البيبلوغرافية
العنوان: Effect of a tailored sepsis treatment protocol on patient outcomes in the Tikur Anbessa Specialized Hospital, Ethiopia: results of an interrupted time series analysis.
المؤلفون: Puchalski Ritchie LM; Department of Medicine, University of Toronto, Toronto, Canada. lisa.puchalskiritchie@utoronto.ca.; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada. lisa.puchalskiritchie@utoronto.ca.; Department of Emergency Medicine, University Health Network, Toronto, Canada. lisa.puchalskiritchie@utoronto.ca.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. lisa.puchalskiritchie@utoronto.ca., Beza L; Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia., Debebe F; Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia., Wubetie A; Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia., Gamble K; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada., Lebovic G; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada., Straus SE; Department of Medicine, University of Toronto, Toronto, Canada.; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada., Zewdu T; Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia., Azazh A; Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia., Hunchak C; Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Canada., Landes M; Department of Emergency Medicine, University Health Network, Toronto, Canada.; Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Canada., Huluka DK; Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
المصدر: Implementation science : IS [Implement Sci] 2022 Jul 19; Vol. 17 (1), pp. 45. Date of Electronic Publication: 2022 Jul 19.
نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 101258411 Publication Model: Electronic Cited Medium: Internet ISSN: 1748-5908 (Electronic) Linking ISSN: 17485908 NLM ISO Abbreviation: Implement Sci Subsets: MEDLINE
أسماء مطبوعة: Original Publication: [London] : BioMed Central, 2006-
مواضيع طبية MeSH: Sepsis*/drug therapy, Anti-Bacterial Agents/therapeutic use ; Clinical Protocols ; Ethiopia ; Hospitals ; Humans ; Interrupted Time Series Analysis
مستخلص: Background: Despite improvement, sepsis mortality rates remain high, with an estimated 11 million sepsis-related deaths globally in 2017 (Rudd et. al, Lancet 395:200-211, 2020). Low- and middle-income countries (LMICs) are estimated to account for 85% of global sepsis mortality; however, evidence for improved sepsis mortality in LMICs is lacking. We aimed to improve sepsis care and outcomes through development and evaluation of a sepsis treatment protocol tailored to the Tikur Anbessa Specialized Hospital Emergency Department, Ethiopia, context.
Methods: We employed a mixed methods design, including an interrupted times series study, pre-post knowledge testing, and process evaluation. The primary outcome was the proportion of patients receiving appropriate sepsis care (blood culture collection before antibiotics and initiation of appropriate antibiotics within 1 h of assessment). Secondary outcomes included time to antibiotic administration, 72-h sepsis mortality, and 90-day all-cause mortality. Due to poor documentation, we were unable to assess our primary outcome and time to antibiotic administration. We used segmented regression with outcomes as binomial proportions to assess the impact of the intervention on mortality. Pre-post knowledge test scores were analyzed using the Student's t-test to compare group means for percentage of scenarios with correct diagnosis.
Results: A total of 113 and 300 patients were enrolled in the pre-implementation and post-implementation phases respectively. While age and gender were similar across the phases, a higher proportion (31 vs. 57%) of patients had malignancies in the post-implementation phase. We found a significant change in trend between the phases, with a trend for increasing odds of survival in the pre-implementation phase (OR 1.24, 95% CI 0.98-1.56), and a shift down, with odds of survival virtually flat (OR 0.95, 95% CI. 0.88-1.03) in the post-implementation phases for 72-h mortality, and trends for survival pre- and post-implementation are virtually flat for 90-day mortality. We found no significant difference in pre-post knowledge test scores, with interpretation limited by response rate. Implementation quality was negatively impacted by resource challenges.
Conclusion: We found no improvement in sepsis outcomes, with a trend for increasing odds of survival lost post-implementation and no significant change in knowledge pre- and post-implementation. Variable availability of resources was the principal barrier to implementation.
Trial Registration: Open Science Framework osf.io/ju4ga . Registered June 28, 2017.
(© 2022. The Author(s).)
References: Intensive Care Med. 2020 Aug;46(8):1552-1562. (PMID: 32572531)
Crit Care. 2018 Sep 23;22(1):232. (PMID: 30243300)
J Antimicrob Chemother. 2011 Apr;66 Suppl 2:ii11-23. (PMID: 21398303)
BMC Res Notes. 2015 Oct 24;8:605. (PMID: 26499999)
Curr Opin Crit Care. 2018 Jun;24(3):190-195. (PMID: 29634494)
Chest. 2014 Jun;145(6):1407-1418. (PMID: 24889440)
Qual Saf Health Care. 2005 Feb;14(1):26-33. (PMID: 15692000)
Lancet. 2020 Jan 18;395(10219):200-211. (PMID: 31954465)
Crit Care Med. 2014 Nov;42(11):2315-24. (PMID: 25072757)
Implement Sci. 2011 Apr 23;6:42. (PMID: 21513547)
Implement Sci. 2015 Feb 12;10:21. (PMID: 25889199)
N Engl J Med. 2014 May 1;370(18):1683-93. (PMID: 24635773)
Semin Respir Crit Care Med. 2010 Feb;31(1):19-30. (PMID: 20101544)
N Engl J Med. 2015 Apr 2;372(14):1301-11. (PMID: 25776532)
BMC Pregnancy Childbirth. 2020 May 14;20(1):297. (PMID: 32410594)
N Engl J Med. 2011 Jun 30;364(26):2483-95. (PMID: 21615299)
Lancet Infect Dis. 2009 Sep;9(9):577-82. (PMID: 19695494)
BMC Health Serv Res. 2019 Mar 20;19(1):181. (PMID: 30894150)
JAMA. 2016 Feb 23;315(8):801-10. (PMID: 26903338)
Qual Health Res. 2005 Nov;15(9):1277-88. (PMID: 16204405)
Pak J Med Sci. 2020 May-Jun;36(4):668-672. (PMID: 32494253)
Crit Care Med. 2012 Jul;40(7):2050-8. (PMID: 22564958)
JAMA. 2017 Oct 3;318(13):1233-1240. (PMID: 28973227)
JAMA. 2018 Jun 5;319(21):2202-2211. (PMID: 29800114)
BMJ. 2014 Mar 07;348:g1687. (PMID: 24609605)
Implement Sci. 2009 Aug 07;4:50. (PMID: 19664226)
Int J Gynaecol Obstet. 2018 Feb;140(2):175-183. (PMID: 29027207)
JAC Antimicrob Resist. 2020 Jul 07;2(3):dlaa039. (PMID: 34240055)
BMC Med. 2013 Apr 18;11:107. (PMID: 23597160)
Ann Am Thorac Soc. 2013 Oct;10(5):509-13. (PMID: 24161054)
N Engl J Med. 2014 Oct 16;371(16):1496-506. (PMID: 25272316)
Heliyon. 2021 Jun 21;7(6):e07362. (PMID: 34222696)
Ann Intensive Care. 2020 Apr 15;10(1):40. (PMID: 32297028)
J Contin Educ Health Prof. 2006 Winter;26(1):13-24. (PMID: 16557505)
معلومات مُعتمدة: KAL-139700 Canada CIHR
فهرسة مساهمة: Keywords: Africa; Ethiopia; Interrupted time series; Sepsis; Treatment protocol
المشرفين على المادة: 0 (Anti-Bacterial Agents)
تواريخ الأحداث: Date Created: 20220719 Date Completed: 20220721 Latest Revision: 20220907
رمز التحديث: 20221213
مُعرف محوري في PubMed: PMC9295292
DOI: 10.1186/s13012-022-01221-8
PMID: 35854310
قاعدة البيانات: MEDLINE
الوصف
تدمد:1748-5908
DOI:10.1186/s13012-022-01221-8