ABSTRACT
AIM: Interventions are required to expedite the identification and treatment of seriously ill children in the emergency department (ED). The aim of this study was to test the hypothesis that the implementation of a features of serious illness in children checklist (FSIC) for ED nursing staff would be associated with a reduction in the presentation-to-treatment time (PTTT) among children who required hospital admission and active treatment. METHODS: An observational study was conducted 8 weeks before and 8 weeks after the implementation of the FSIC. The study was conducted in a busy combined adult and paediatric ED. Participants were children admitted to the hospital via the ED with a potentially life-threatening illness. RESULTS: A total of 3640 patients age less than 18 years attended the ED during the observation period. Of these, 214 patients met the eligibility criteria: 111 pre-FSIC and 103 post-FSIC. The overall ED workload and case-mix were similar during the two observation periods. The PTTT was on average 16% (95% confidence interval, 17-33%; P = 0.302) longer following the implementation of the FSIC. CONCLUSION: The implementation of a checklist to assist ED nursing staff in the identification of seriously ill children was not effective in reducing the delay between presentation and the initiation of treatment among children who were admitted to the hospital. Larger studies are required to determine whether similar strategies are effective among a more critically ill subgroup. Consideration should also be given to alternative strategies to expedite the identification and treatment of seriously ill children in the ED.
Subject(s)
Critical Illness/classification , Emergency Medicine/methods , Nursing Assessment/methods , Triage/methods , Adolescent , Child , Child, Preschool , Critical Illness/nursing , Emergency Service, Hospital , Female , Humans , Infant , Infant, Newborn , Male , Observation , Patient Admission , Severity of Illness Index , Time FactorsABSTRACT
OBJECTIVE: To evaluate the effect of implementation of a sepsis protocol. DESIGN: Before and after cohort study. SETTING: Level III ICU in a tertiary regional hospital, February - July, 2006 (before intervention) and 2007 (after). PARTICIPANTS: Adult patients who fulfilled criteria for severe sepsis or septic shock within 48 hours of ICU admission. INTERVENTION: Implementation of a locally modified sepsis protocol. MAIN OUTCOME MEASURES: Delivery of process of care components, and ICU and hospital mortality. RESULTS: A total of 110 patients were included in the study: 44 in the pre-protocol group, and 66 in the post-protocol group. Demographic variables and severity of illness variables were similar in the two groups except for a lower incidence of respiratory sepsis in the post-protocol group. Post-protocol, there was a shorter time to initiation of appropriate antibiotics, and an increase in the use of vasopressors, deep vein thrombosis prophylaxis, and nutritional support, with no difference in ICU or hospital mortality. There was no difference in resuscitation endpoints at 6, 24, and 72 hours. CONCLUSIONS: Implementation of a sepsis protocol led to a change in the delivery of care with no reduction in mortality in patients with severe sepsis and septic shock admitted to a Level III ICU in a tertiary hospital.
