The management of sepsis in emergencies. Retrospective observational study in the emergency department of Grosseto hospital
Abstract
Sepsis is a frequent, difficult-to-manage clinical condition associated with very high mortality when accompanied by organ failure or a state of shock. Sepsis and septic shock represent a medical emergency. The Golden Hour concept already expressed for other time-dependent diseases applies to sepsis and septic shock. The identification of patients with sepsis and the timely initiation of appropriate treatment have a significant impact on survival and associated morbidity. Since 2016, the Region of Tuscany has undertaken a process of comprehensive and participatory redesign of its emergency room set-ups that aims to integrate the assessment of priority and complexity in order to direct the patient to the most appropriate pathway.
Supporting Agencies
References
- Percorso Sepsi. Gestione della Sepsi e dello Shock Settico, Identificazione e Trattamento - Percorso Diagnostico Terapeutico Assistenziale (PDTA). GRC - Centro Gestione Rischio Clinico e Sicurezza del Paziente, Regione Toscana, 2016. Disponibile presso: https://www.regione.toscana.it/documents/10180/601731/PERCORSO+SEPSI+GRC+TOSCANA_2016.pdf/b8884eca-a4bf-4850-a60e-0f7bacf60912
- M. Singer, C. S. Deutschman, C. Warren Seymour. The Third International Consensus Definitionsfor Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315:801-810
- Accorgi D, Alti E, Barnini S. Lotta alla sepsi > call to action . Documento di indirizzo gruppo tecnico programma regionale di lotta alla sepsi regione Toscana, 2019. Disponibile presso: https://www.ars.toscana.it/lotta-alla-sepsi/lottaAllaSepsi_callToAction
- J M Kahn , B S Davis , J G Yabes . Association Between State-Mandated Protocolized Sepsis Care and In-hospital Mortality Among Adults With Sepsis. JAMA 2019 Jul 16; 322:240-250
- B Andrews, M W. Semler, L Muchemwa. Effect of an Early Resuscitation Protocol on In-hospital Mortality Among Adults With Sepsis and Hypotension. A Randomized Clinical Trial. JAMA 2017; 318:1233-1240
- M. Ruggeri, Vanni S, Paolini D. Manuale di Formazione del sistema triage toscano (STT). 1 ed. Formas, 2019.
- Surviving Sepsis Campaign Responds to Sepsis-3. Disponibile presso: http://www.survivingsepsis.org/News/Pages/Surviving-Sepsis-Campaign-Responds-to-Sepsis-3.aspx. Accesso il 15/07/2020
- Modello organizzativo per percorsi omogenei in Pronto Soccorso. Linee di Indirizzo. Regione Toscana. Delibera n. 806 del 24-07-2017.
- A Shetty , S Pj Macdonald , G Keijzers. Review article: Sepsis in the emergency department – Part 2: Investigations and monitoring. Emerg Med Australas 2018; 30:4-12
- Linee di indirizzo nazionali sul triage intraospedaliero. Ministero della salute, 2019
- T Shah , E Sterk , M A Rech. Emergency department sepsis screening tool decreases time to antibiotics in patients with sepsis. Am J Emerg Med 2018; 36:1745-1748
- I Martin-Loeches , J F Timsit , M Leone. Clinical controversies in abdominal sepsis. Insights for critical care settings. J Crit Care 2019; 53:53-58
- S P Macdonald , J M Williams, A Shetty . Review article: Sepsis in the emergency department - Part 1: Definitions and outcomes. Emerg Med Australas 2017; 9:619-625
- Giornata mondiale per la lotta alla sepsi. Disponibile presso: https://www.salute.gov.it/portale/news/p3_2_1_1_1.jsp?lingua=italiano&menu=notizie&p=dalministero&id=5038. Accesso il 13/06/21
- Rudd K E, Johnson S C, Agesa K M. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet 2020; 395:200-211
- Ortega R N, Rosin C, Bingisser R. Clinical Scores and Formal Triage for Screening of Sepsis and Adverse Outcomes on Arrival in an Emergency Department All-Comer Cohort. J Emerg Med 2019; 57:453-460
- Romero B , Fry M , Roche M. The impact of evidence-based sepsis guidelines on emergency department clinical practice: a pre-post medical record audit. J Clin Nurs 2017; 26:3588-3596
- Hayden G E, Tuuri R E, Scott R. Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED. Am J Emerg Med 2016; 34:1-9
- Gatewood M O , Wemple M, Sheryl Greco S. A quality improvement project to improve early sepsis care in the emergency department. BMJ Qual Saf 2015; 24:787-95
- Torsvik M , Gustad L T, Mehl A. Early identification of sepsis in hospital inpatients by ward nurses increases 30-day servival. Crit Care 2016; 20:244
- H R Bruce , J Maiden , P F Fedullo. Impact of nurse-initiated ED sepsis protocol on compliance with sepsis bundles, time to initial antibiotic administration, and in-hospital mortality. J Emerg Nurs 2015; 41(2):130-7
- Nevill A, Kuhn L, Thompson. The influence of nurse allocated triage category on the care of patients with sepsis in the emergency department: A retrospective review. Australas Emerg Care 2021; 24:121-126
- Chamberlain D J, Willis E, Clark R. Identification of the severe sepsis patient at triage: a prospective analysis of the Australasian Triage Scale. Emerg Med J Published Online First 2014; 0:1–8
- Triage e sepsi 2015. Un anno di attività del sistema di triage regionale del Friuli Venezia Giulia. Disponibile presso. www.simeu.it/w/congresso2016/presentazioni/view/262. Accesso il 20/7/2018
Metrics
Citations and online attention from Dimensions, Altmetric and PlumX.
License
Copyright (c) 2021 Scenario

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Aniarti has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.