PDF(Pubmed)
Abstract：
UNASSIGNED: The Pediatric Surviving Sepsis Campaign supports the implementation of automated tools for early sepsis recognition. In 2019 the C.S. Mott Children\'s Hospital Pediatric Intensive Care Unit deployed an electronic medical record (EMR)-based screening for early recognition and treatment of sepsis.
UNASSIGNED: We analyzed all automated primary sepsis alerts, secondary screens, and bedside huddles from November 2019 to January 2020 (Cohort 1) and from November 2020 to January 2021 (Cohort 2) to identify barriers and facilitators for the use of this tool. We distributed surveys to frontline providers to gather feedback on end-user experience.
UNASSIGNED: In Cohort 1, 895 primary alerts were triggered, yielding 503 completed secondary screens and 40 bedside huddles. In Cohort 2, 925 primary alerts were triggered, yielding 532 completed secondary screens and 12 bedside huddles. Surveys assessing end-user experience identified the following facilitators: (1) 73% of nurses endorsed the bedside huddle as value added; (2) 74% of medical providers agreed the bedside huddle increased the likelihood of interventions. The greatest barriers to successful implementation included the (1) overall large number of primary alerts from the automated tool and (2) rate of false alerts, many due to routine respiratory therapy interventions.
UNASSIGNED: Our data suggests that the successful implementation of EMR-based sepsis screening tools requires countermeasures focusing on 3 key drivers for change: education, technology, and patient safety.
UNASSIGNED: While both medical providers and bedside nurses found merit in our EMR-based sepsis early recognition system, continued refinement is necessary to avoid sepsis alert fatigue.
UNASSIGNED: We analyzed all automated primary sepsis alerts, secondary screens, and bedside huddles from November 2019 to January 2020 (Cohort 1) and from November 2020 to January 2021 (Cohort 2) to identify barriers and facilitators for the use of this tool. We distributed surveys to frontline providers to gather feedback on end-user experience.
UNASSIGNED: In Cohort 1, 895 primary alerts were triggered, yielding 503 completed secondary screens and 40 bedside huddles. In Cohort 2, 925 primary alerts were triggered, yielding 532 completed secondary screens and 12 bedside huddles. Surveys assessing end-user experience identified the following facilitators: (1) 73% of nurses endorsed the bedside huddle as value added; (2) 74% of medical providers agreed the bedside huddle increased the likelihood of interventions. The greatest barriers to successful implementation included the (1) overall large number of primary alerts from the automated tool and (2) rate of false alerts, many due to routine respiratory therapy interventions.
UNASSIGNED: Our data suggests that the successful implementation of EMR-based sepsis screening tools requires countermeasures focusing on 3 key drivers for change: education, technology, and patient safety.
UNASSIGNED: While both medical providers and bedside nurses found merit in our EMR-based sepsis early recognition system, continued refinement is necessary to avoid sepsis alert fatigue.
摘要：
■小儿败血症生存运动支持实施用于早期败血症识别的自动化工具。2019年，C.S.Mott儿童医院儿科重症监护病房部署了基于电子病历（EMR）的筛查，以早期识别和治疗败血症。
■我们分析了所有自动的主要败血症警报，二级屏幕,从2019年11月至2020年1月（第1组）和从2020年11月至2021年1月（第2组），以确定使用此工具的障碍和促进者。我们向一线提供商分发了调查，以收集有关最终用户体验的反馈。
■在队列1中，触发了895个主要警报，产生503个完成的二次筛子和40个床边挤塞。在队列2中，触发了925个主要警报，产生532个完成的二次屏幕和12个床边挤。评估最终用户体验的调查确定了以下促进因素：（1）73％的护士认可床边挤做是增值；（2）74％的医疗提供者同意床边挤做增加了干预的可能性。成功实施的最大障碍包括（1）来自自动化工具的大量主要警报和（2）错误警报的发生率，许多是由于常规的呼吸治疗干预。
■我们的数据表明，成功实施基于EMR的败血症筛查工具需要采取对策，重点关注变革的3个关键驱动因素：教育，技术,和患者安全。
虽然医疗提供者和床边护士都发现了我们基于EMR的脓毒症早期识别系统的优点，继续细化是必要的，以避免脓毒症警报疲劳。
■我们分析了所有自动的主要败血症警报，二级屏幕,从2019年11月至2020年1月（第1组）和从2020年11月至2021年1月（第2组），以确定使用此工具的障碍和促进者。我们向一线提供商分发了调查，以收集有关最终用户体验的反馈。
■在队列1中，触发了895个主要警报，产生503个完成的二次筛子和40个床边挤塞。在队列2中，触发了925个主要警报，产生532个完成的二次屏幕和12个床边挤。评估最终用户体验的调查确定了以下促进因素：（1）73％的护士认可床边挤做是增值；（2）74％的医疗提供者同意床边挤做增加了干预的可能性。成功实施的最大障碍包括（1）来自自动化工具的大量主要警报和（2）错误警报的发生率，许多是由于常规的呼吸治疗干预。
■我们的数据表明，成功实施基于EMR的败血症筛查工具需要采取对策，重点关注变革的3个关键驱动因素：教育，技术,和患者安全。
虽然医疗提供者和床边护士都发现了我们基于EMR的脓毒症早期识别系统的优点，继续细化是必要的，以避免脓毒症警报疲劳。
