دورية أكاديمية
Order Set Usage is Associated With Lower Hospital Mortality in Patients With Sepsis.
العنوان: | Order Set Usage is Associated With Lower Hospital Mortality in Patients With Sepsis. |
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المؤلفون: | Dale CR; Swedish Health Services, Seattle, WA.; School of Public Health, University of Washington, Seattle, WA., Schoepflin Sanders S; Providence St. Vincent Medical Center, Portland, OR., Chang SC; Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Portland, OR.; Providence Research Network, Renton, WA., Pandhair O; Providence St. Vincent Medical Center, Portland, OR., Diggs NG; Swedish Health Services, Seattle, WA., Woodruff W; Providence, Renton, WA., Selander DN; Swedish Health Services, Seattle, WA., Mark NM; Swedish Health Services, Seattle, WA., Nurse S; Providence, Renton, WA., Sullivan M; Swedish Health Services, Seattle, WA., Mezaraups L; Providence, Renton, WA., O'Mahony DS; Swedish Health Services, Seattle, WA.; Department of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA. |
المصدر: | Critical care explorations [Crit Care Explor] 2023 May 16; Vol. 5 (5), pp. e0918. Date of Electronic Publication: 2023 May 16 (Print Publication: 2023). |
نوع المنشور: | Journal Article |
اللغة: | English |
بيانات الدورية: | Publisher: Wolters Kluwer Health Country of Publication: United States NLM ID: 101746347 Publication Model: eCollection Cited Medium: Internet ISSN: 2639-8028 (Electronic) Linking ISSN: 26398028 NLM ISO Abbreviation: Crit Care Explor Subsets: PubMed not MEDLINE |
أسماء مطبوعة: | Original Publication: Philadelphia, PA : Wolters Kluwer Health, [2019]- |
مستخلص: | The Surviving Sepsis Campaign recommends standard operating procedures for patients with sepsis. Real-world evidence about sepsis order set implementation is limited. Objectives: To estimate the effect of sepsis order set usage on hospital mortality. Design: Retrospective cohort study. Setting and Participants: Fifty-four acute care hospitals in the United States from December 1, 2020 to November 30, 2022 involving 104,662 patients hospitalized for sepsis. Main Outcomes and Measures: Hospital mortality. Results: The sepsis order set was used in 58,091 (55.5%) patients with sepsis. Initial mean sequential organ failure assessment score was 0.3 lower in patients for whom the order set was used than in those for whom it was not used (2.9 sd [2.8] vs 3.2 [3.1], p < 0.01). In bivariate analysis, hospital mortality was 6.3% lower in patients for whom the sepsis order set was used (9.7% vs 16.0%, p < 0.01), median time from emergency department triage to antibiotics was 54 minutes less (125 interquartile range [IQR, 68-221] vs 179 [98-379], p < 0.01), and median total time hypotensive was 2.1 hours less (5.5 IQR [2.0-15.0] vs 7.6 [2.5-21.8], p < 0.01) and septic shock was 3.2% less common (22.0% vs 25.4%, p < 0.01). Order set use was associated with 1.1 fewer median days of hospitalization (4.9 [2.8-9.0] vs 6.0 [3.2-12.1], p < 0.01), and 6.6% more patients discharged to home (61.4% vs 54.8%, p < 0.01). In the multivariable model, sepsis order set use was independently associated with lower hospital mortality (odds ratio 0.70; 95% CI, 0.66-0.73). Conclusions and Relevance: In a cohort of patients hospitalized with sepsis, order set use was independently associated with lower hospital mortality. Order sets can impact large-scale quality improvement efforts. Competing Interests: The authors declare that they are or were employees of Providence and its affiliates and have no other real or perceived conflicts of interest. (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.) |
References: | Crit Care Med. 2006 Nov;34(11):2707-13. (PMID: 16943733) JAMA Netw Open. 2019 Feb 1;2(2):e187571. (PMID: 30768188) Healthcare (Basel). 2018 Nov 19;6(4):. (PMID: 30463180) Emerg Med Australas. 2016 Aug;28(4):399-403. (PMID: 27147126) Crit Care Med. 2009 Mar;37(3):819-24. (PMID: 19237883) Crit Care Med. 2014 Aug;42(8):1749-55. (PMID: 24717459) Crit Care Med. 2010 Apr;38(4):1045-53. (PMID: 20048677) West J Emerg Med. 2018 Sep;19(5):774-781. (PMID: 30202487) Crit Care Med. 2006 Jun;34(6):1589-96. (PMID: 16625125) Expert Rev Anti Infect Ther. 2009 Nov;7(9):1075-9. (PMID: 19883327) JAMA. 2001 Oct 10;286(14):1754-8. (PMID: 11594901) Crit Care Med. 2014 Mar;42(3):583-91. (PMID: 24152590) Crit Care Med. 2017 Apr;45(4):623-629. (PMID: 28169944) Am J Respir Crit Care Med. 2017 Oct 1;196(7):856-863. (PMID: 28345952) Lancet Reg Health West Pac. 2021 Nov 02;18:100305. (PMID: 35024649) Jt Comm J Qual Patient Saf. 2015 May;41(5):205-11. (PMID: 25977247) Appl Clin Inform. 2018 Oct;9(4):869-874. (PMID: 30517970) Int J Pharm Pract. 2021 Oct 18;29(5):493-498. (PMID: 34302480) Crit Care Med. 2021 Nov 1;49(11):e1063-e1143. (PMID: 34605781) Acad Emerg Med. 2019 Aug;26(8):908-920. (PMID: 30343515) BMC Health Serv Res. 2022 Jul 30;22(1):975. (PMID: 35907839) Crit Care Med. 2010 Apr;38(4):1036-43. (PMID: 20154597) Clin Epidemiol. 2017 Jun 08;9:331-338. (PMID: 28652815) Heart Lung. 2021 Jul-Aug;50(4):477-480. (PMID: 33831699) Intensive Care Med. 1996 Jul;22(7):707-10. (PMID: 8844239) Intensive Care Med. 2014 Nov;40(11):1623-33. (PMID: 25270221) Clin Nurse Spec. 2011 Jul-Aug;25(4):180-5. (PMID: 21654373) Qual Saf Health Care. 2010 Oct;19(5):e46. (PMID: 20671074) J Intensive Care Med. 2018 Oct;33(10):551-556. (PMID: 28385107) Crit Care Med. 2017 Feb;45(2):241-252. (PMID: 27661863) Milbank Mem Fund Q. 1966 Jul;44(3):Suppl:166-206. (PMID: 5338568) |
فهرسة مساهمة: | Keywords: clinical decision support; health services; order set; quality improvement; sepsis |
تواريخ الأحداث: | Date Created: 20230519 Latest Revision: 20230522 |
رمز التحديث: | 20240628 |
مُعرف محوري في PubMed: | PMC10191554 |
DOI: | 10.1097/CCE.0000000000000918 |
PMID: | 37206374 |
قاعدة البيانات: | MEDLINE |
تدمد: | 2639-8028 |
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DOI: | 10.1097/CCE.0000000000000918 |