TY -的AU -李,安迪Hung-Yi AU - Aaronson,艾米丽盟——Hibbert凯瑟琳AU -弗林,弥迦书H盟——Rutkey海莉AU -莫特,伊丽莎白盟——索尼,乔纳森•D AU -影响Kyan C PY - 2021 DA - 2021/6/24 TI -实时监控平台的设计和实现最优脓毒症护理在紧急部门:观察性队列研究乔- J地中海互联网Res SP - e26946六世- 23 - 6千瓦电子监控平台KW -败血症KW -质量改进AB -背景:败血症是美国医院的主要死亡原因。遵守捆绑护理，特别是系列乳酸盐、血培养和抗生素，可改善结果，但在繁忙的实践环境中往往被延误或完全错过。目的:本研究旨在设计、实施和验证一种新型的监测和警报平台，为一线急诊科(ED)提供者提供关于捆绑护理依从性的实时反馈。方法:这项单中心、前瞻性、观察性研究分三个阶段进行:设计和技术开发阶段，构建平台的初始版本;试点阶段，在临床环境中测试和改进平台;以及全面实施研究干预的试点后推广阶段。结果:在设计和技术开发过程中，研究团队成员和利益相关者确定了纳入患者的标准，从医疗保险和医疗补助脓毒症警报核心措施中心选择了捆绑措施，并定义了警报阈值、消息内容、传递机制和接收人。在试验阶段，基于70个提供者的调查结果进行了额外的改进，包括删除血管加压药物启动的警报，修改页面中的文本以方便患者识别。在试验推广阶段的48天内，跟踪了15770例ED遭遇，711例患者遭遇纳入了主动监测队列。 In total, 634 pages were sent at a rate of 0.98 per attending physician shift. Overall, 38.3% (272/711) patients had at least one page. The missing bundle elements that triggered alerts included: antibiotics 41.6% (136/327), repeat lactate 32.4% (106/327), blood cultures 20.8% (68/327), and initial lactate 5.2% (17/327). Of the missing Sepsis Core Measures elements for which a page was sent, 38.2% (125/327) were successfully completed on time. Conclusions: A real-time sepsis care monitoring and alerting platform was created for the ED environment. The high proportion of patients with at least one alert suggested the significant potential for such a platform to improve care, whereas the overall number of alerts per clinician suggested a low risk of alarm fatigue. The study intervention warrants a more rigorous evaluation to ensure that the added alerts lead to better outcomes for patients with sepsis. SN - 1438-8871 UR - //www.mybigtv.com/2021/6/e26946/ UR - https://doi.org/10.2196/26946 UR - http://www.ncbi.nlm.nih.gov/pubmed/34185009 DO - 10.2196/26946 ID - info:doi/10.2196/26946 ER -