Transsectoral optimization of sepsis care processes based on interoperable routine data (optiSEP): Results of a monocentric pilot study
The study demonstrates that transsectoral data collection for sepsis care is feasible, but adherence to guidelines varies significantly across different care settings.
Where it sits
this study against the rest of the vasopressin corpusSummary and findings
This pilot study evaluated the feasibility of merging data from emergency services, emergency departments, and inpatient care for patients with sepsis or severe infection. A total of 39 patients were assessed over a four-week period. The study focused on documentation completeness and guideline adherence.
Abstract
<title>Abstract</title> <p>Background and importance In order to improve emergency care for sepsis the optiSEP project aims to establish a transsectoral dataset from emergency and inpatient care. Objective The aim of this pilot study was to evaluate the feasibility of merging data from emergency services (ES), emergency departments (EDs) and inpatients in preparation for the optiSEP trial. Design, settings and participants In this monocentric pilot study a retrospective data collection of 39 patients with sepsis (+/- shock) or severe infection was performed over a four-week period. Completeness of the data set (primary endpoint) and guideline adherence using predefined process indicators (secondary endpoints) were assessed. Outcome measures and analysis Data were extracted from routine documentation and entered into an electronic case report form (RedCap). Descriptive statistics were used to summarize primary and secondary endpoints. Results The documentation completeness was highest in the ED. The fulfilling of the process indicators was heterogenous in the three care sectors. The qSOFA score was exclusively recorded in the ED in 23% of patients. Lactate levels were available in 97% of ED and in all intensive/intermediate care (ICU/IMC) patients. Blood culture sets were taken at 100% in the ED before initiation of antibiotic treatment in 95% of patients. All ICU/IMC patients received antibiotic therapy including day 7 compared to 94% on normal care (NC) wards on day 3 and 88% on day 7. Fluid resuscitation was documented in 28% preclinically and in 80% of ED patients. On ICU/IMC patients received volume administration in 67% on day 3 and 7, on NC 18% on day 3 and 24% on day 7. Vasopressores were applied in one patient preclinically, in 15% in the ED, in 67% on ICU/IMC on day 3 and 25% on day 7. Next-Generation sequencing (NGS) diagnostics was performed in approximately half of the patients. Conclusions The transsectoral collection of routine data along the digital rescue chain is feasible and allows comprehensive assessment of the quality of care in sepsis thus leading to the identification of critical steps in diagnostics and therapies to optimize patient's outcome.</p>
Background
This study addresses the clinical need for improved emergency care processes in sepsis management. Prior research has highlighted the importance of timely and accurate data collection in sepsis care. The optiSEP project aims to establish a comprehensive dataset to enhance the quality of care across different healthcare sectors.
Methods
This monocentric pilot study involved a retrospective data collection of 39 patients with sepsis or severe infection over a four-week period. The primary endpoint was the completeness of the data set, while secondary endpoints included guideline adherence using predefined process indicators. Data were extracted from routine documentation and analyzed using descriptive statistics.
Results
The primary endpoint of documentation completeness was highest in the emergency department (ED). The qSOFA score was recorded in 23% of patients in the ED. Blood culture sets were taken at 100% in the ED before initiation of antibiotic treatment in 95% of patients. Fluid resuscitation was documented in 80% of ED patients, while vasopressors were applied in 67% of ICU/IMC patients on day 3.
Interpretation
The findings suggest that while documentation completeness is high in certain areas, there are inconsistencies in guideline adherence across different care sectors. The effect sizes observed, such as 100% blood culture collection in the ED, may be statistically significant but do not necessarily translate to improved clinical outcomes without further evidence. Limitations include the small sample size and the monocentric nature of the study, which may restrict broader applicability.
Key findings
- Documentation completeness was highest in the ED.
- Blood culture sets were taken at 100% in the ED before initiation of antibiotic treatment in 95% of patients.
- Fluid resuscitation was documented in 28% preclinically and in 80% of ED patients.
- Vasopressors were applied in one patient preclinically, in 15% in the ED, in 67% on ICU/IMC on day 3 and 25% on day 7.
- Lactate levels were available in 97% of ED and in all ICU/IMC patients.
Limitations
- small n=39 pilot study
- monocentric design limits generalizability
- retrospective data collection may introduce bias
- short follow-up period of four weeks