Impact of a multidisciplinary sepsis huddle in the emergency department.

BACKGROUND: Sepsis is a leading cause of death in hospitals requiring prompt recognition and treatment. The sepsis bundle is the cornerstone of sepsis treatment. Studies have evaluated the impact of a sepsis huddle on sepsis bundle compliance but not in sepsis identification. OBJECTIVE: Measure the effect of a multidisciplinary sepsis bedside huddle in the Emergency Department (ED) on sepsis identification and sepsis bundle compliance. METHODS: Retrospective, single-center, cohort study. Pre-huddle patients were identified via Best Practice Advisory (BPA) alert on the electronic medical record from 11/01/2019-3/31/2020. The post-huddle group were patients for whom a sepsis huddle was activated from 11/01/2020-3/31/2021. RESULTS: 116 patients met inclusion criteria and 15 were determined to not have sepsis for a total of 21 pre-huddle and 80 post-huddle patients. Comparing pre-post results, sepsis huddle increased code sepsis activation (10% vs 91%, p < 0.001); sepsis bundle compliance (24% vs 80%, p < 0.001); antibiotics within one hour (33% vs 90%, p < 0.001); culture within one hour (67% vs 95%, p < 0.001), order entry <30 min. (29% vs 86%, p < 0.001); and median order entry time (48 vs. 3 min, p < 0.001). Post-huddle, 80% of order entries were ≤ 20 min. Logistic regression predicting sepsis code found huddle to be the first predictor, (p < 0.0000005). Hour-1 bundle compliance was predicted by physician/physician assistant order ≤30 min (R2 = 0.36, p < 0.0000005). CONCLUSION: Sepsis bedside huddle in the ED improves identification and sepsis bundle compliance. Results suggest increased order entry speed caused bundle improvement.

Otitis media guidelines for Australian Aboriginal and Torres Strait Islander children: summary of recommendations.

INTRODUCTION: The 2001 Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Islander populations were revised in 2010. This 2020 update by the Centre of Research Excellence in Ear and Hearing Health of Aboriginal and Torres Strait Islander Children used for the first time the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. MAIN RECOMMENDATIONS: We performed systematic reviews of evidence across prevention, diagnosis, prognosis and management. We report ten algorithms to guide diagnosis and clinical management of all forms of otitis media. The guidelines include 14 prevention and 37 treatment strategies addressing 191 questions. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES: A GRADE approach is used. Targeted recommendations for both high and low risk children. New tympanostomy tube otorrhoea section. New Priority 5 for health services: annual and catch-up ear health checks for at-risk children. Antibiotics are strongly recommended for persistent otitis media with effusion in high risk children. Azithromycin is strongly recommended for acute otitis media where adherence is difficult or there is no access to refrigeration. Concurrent audiology and surgical referrals are recommended where delays are likely. Surgical referral is recommended for chronic suppurative otitis media at the time of diagnosis. The use of autoinflation devices is recommended for some children with persistent otitis media with effusion. Definitions for mild (21-30 dB) and moderate (> 30 dB) hearing impairment have been updated. New "OMapp" enables free fast access to the guidelines, plus images, animations, and multiple Aboriginal and Torres Strait Islander language audio translations to aid communication with families.

Outcomes of primary myringoplasty in indigenous children from the Northern Territory of Australia.

AIM: To report the surgical and audiological outcomes of myringoplasty (Type I tympanoplasty) in Indigenous Australian children living in remote and regional communities in northern Australia. METHOD: An observational cohort study, with prospective recording of the details of surgery. Audiological outcomes were collected independently, and these data were integrated in the present study. Children aged 5-18 year underwent myringoplasty in the Northern Territory during a program initiated by the Australian Government. Surgery was performed by surgeons drawn from across Australia. RESULTS: 412 primary myringoplasties were performed. The mean age at surgery was 11 years. The tympanic membrane was closed in 64.2% of cases. Fascial grafting was associated with greater surgical success than cartilage. Dryness of the ear at surgery did not affect drum closure. Post-operative aural discharge was half that reported in historical literature. Surgical success was independent of the patient's age at surgery. Post-operative audiograms were available on 216 cases. At last review, hearing had improved even when the operation was not a surgical success, with hearing aid candidacy falling from 84 to 34%. Hearing was similar irrespective of the size of the perforation at surgery or the graft used and did not change with the time between surgery and review. The best hearing was associated with drum closure and Types A or C tympanograms. A conductive hearing loss persisted after surgery that was greater when there was an immobile drum. CONCLUSIONS: Indigenous children benefited from myringoplasty, even when the operation was not a "surgical success" as deemed by drum closure. There lower incidence of post-operative discharge from persistent perforations suggests an improvement in the ear health of the population. A persistent conductive loss persists, likely a consequence of the underlying disease but possibly from the surgery.

Povidone-iodine ear wash and oral cotrimoxazole for chronic suppurative otitis media in Australian aboriginal children: study protocol for factorial design randomised controlled trial.

BACKGROUND: Chronic suppurative otitis media (CSOM) is a significant health issue affecting Aboriginal Australians. Long-term hearing loss can cause communication problems, educational disadvantage, and social isolation. Current standard treatment for CSOM in our region is twice daily dry mopping of the pus from the ear canal followed by instillation of ciprofloxacin antibiotic ear drops for up to 16 weeks, or until the discharge resolves for a period of 3 days. The treatment is long, laborious and fails to resolve ear discharge in 70% of cases in remote communities. Bacterial pathogens also persist. Povidone-iodine ear wash is the preferred method of clearing ear discharge in Western Australia. However, evidence of its effectiveness is lacking. In systematic reviews, topical antibiotics (ciprofloxacin) have been shown to be more effective than oral antibiotics or topical antiseptics. Currently, it is unclear whether there are any benefits of combining these treatments. METHODS: This protocol describes a 2 × 2 factorial randomised controlled trial of two different interventions (povidone-iodine ear wash and oral cotrimoxazole), given as adjunctive therapy to standard treatment for CSOM. 280 children, between 2 months and 17 years of age, Indigenous or non-Indigenous, living in participating Northern Territory (NT) communities are randomised to standard treatment (dry mopping and ciprofloxacin drops) plus one of two topical treatments (dilute povidone-iodine ear wash or no wash) and one of two oral medication treatments (16 weeks of cotrimoxazole or placebo). DISCUSSION: Current treatment of CSOM in our region shows that eradication of bacterial pathogens from the middle ear space and dry ears is often not achieved. This trial will evaluate the efficacy of adjunctive treatments of antiseptic ear washes and oral antibiotics. Clinical, microbiological and hearing outcomes will be reported. TRIAL REGISTRATION: This trial (ACTRN12614000234617) was registered with ANZCTR on 05 April 2014.