目的:确定改善医院败血症护理的机会,并为密歇根州正在进行的全州质量改进计划提供信息。
方法:医院败血症过程调查,包括使用3点李克特量表对实践进行自我评估,对参加密歇根医院医学安全联盟的51家医院进行了管理,由密歇根州蓝十字蓝盾赞助的合作质量倡议,在两个时间点(2020年、2022年)。48家医院也提交了败血症方案进行结构化审查。
方法:多中心质量改进联盟。
方法:密歇根州的51家医院。
方法:无。
结果:在纳入的医院中,92.2%(n=47/51)是非营利组织,88.2%(n=45/51)城市,11.8%(n=6/51)农村,80.4%(n=41/51)的教学医院。百分之一百(n=51/51)对调查做出了回应,94.1%(n=48/51)提供了脓毒症策略/方案。所有接受调查的医院至少使用了一种质量改进方法,包括审计/反馈(98.0%,n=50/51)和/或临床医师教育(68.6%,n=35/51)。方案包括脓毒症-1(18.8%,n=9/48)或脓毒症-2(31.3%,n=15/48)定义;没有(n=0/48)使用脓毒症-3。所有医院(n=51/51)都使用至少一种方法来促进败血症的快速治疗,包括订单集(96.1%,n=49/51)和/或在至少一种临床环境中储备常用抗生素(92.2%,n=47/51)。治疗方案包括抗菌治疗指导(68.8%,n=33/48),液体复苏(70.8%,n=34/48),和血管加压药给药(62.5%,n=30/48)。关于自我评估,医院报告的出院期间评分最低,包括认知障碍筛查(2.0%,n=1/51回答“我们擅长这一点”)并提供预期指导(3.9%,n=2/51)。医疗保险和医疗补助服务中心“严重败血症和败血症休克:管理捆绑表现与医院特征或败血症政策文件特征的差异”之间没有有意义的关联。
结论:大多数医院使用审计/反馈,订单集,和临床医生教育,以促进败血症护理。医院没有一致地将器官功能障碍标准纳入脓毒症定义。现有流程侧重于早期识别和治疗,而不是基于恢复的做法。
OBJECTIVE: To identify opportunities for improving hospital-based sepsis care and to inform an ongoing statewide quality improvement initiative in Michigan.
METHODS: Surveys on hospital sepsis processes, including a self-assessment of practices using a 3-point Likert scale, were administered to 51 hospitals participating in the Michigan Hospital Medicine Safety Consortium, a Collaborative Quality Initiative sponsored by Blue Cross Blue Shield of Michigan, at two time points (2020, 2022). Forty-eight hospitals also submitted sepsis protocols for structured review.
METHODS: Multicenter quality improvement consortium.
METHODS: Fifty-one hospitals in Michigan.
METHODS: None.
RESULTS: Of the included hospitals, 92.2% (n = 47/51) were nonprofit, 88.2% (n = 45/51) urban, 11.8% (n = 6/51) rural, and 80.4% (n = 41/51) teaching hospitals. One hundred percent (n = 51/51) responded to the survey, and 94.1% (n = 48/51) provided a sepsis policy/protocol. All surveyed hospitals used at least one quality improvement approach, including audit/feedback (98.0%, n = 50/51) and/or clinician education (68.6%, n = 35/51). Protocols included the Sepsis-1 (18.8%, n = 9/48) or Sepsis-2 (31.3%, n = 15/48) definitions; none (n = 0/48) used Sepsis-3. All hospitals (n = 51/51) used at least one process to facilitate rapid sepsis treatment, including order sets (96.1%, n = 49/51) and/or stocking of commonly used antibiotics in at least one clinical setting (92.2%, n = 47/51). Treatment protocols included guidance on antimicrobial therapy (68.8%, n = 33/48), fluid resuscitation (70.8%, n = 34/48), and vasopressor administration (62.5%, n = 30/48). On self-assessment, hospitals reported the lowest scores for peridischarge practices, including screening for cognitive impairment (2.0%, n = 1/51 responded \"we are good at this\") and providing anticipatory guidance (3.9%, n = 2/51). There were no meaningful associations of the Centers for Medicare and Medicaid Services\' Severe Sepsis and Septic Shock: Management Bundle performance with differences in hospital characteristics or sepsis policy document characteristics.
CONCLUSIONS: Most hospitals used audit/feedback, order sets, and clinician education to facilitate sepsis care. Hospitals did not consistently incorporate organ dysfunction criteria into sepsis definitions. Existing processes focused on early recognition and treatment rather than recovery-based practices.