Early identification of sepsis in hospital inpatients by ward nurses increases 30-day survival

Abstract

Background: Systemic inflammatory response syndrome (SIRS) and sepsis are now frequently identified by observations of vital signs and detection of organ failure during triage in the emergency room. However, there is less focus on the effect on patient outcome with better observation and treatment at the ward level.

Methods: This was a before-and-after intervention study in one emergency and community hospital within the Mid-Norway Sepsis Study catchment area. All patients with confirmed bloodstream infection have been prospectively registered continuously since 1994. Severity of sepsis, observation frequency of vital signs, treatment data, length of stay (LOS) in high dependency and intensive care units, and mortality were retrospectively registered from the patients' medical journals.

Results: The post-intervention group (n = 409) were observed better and had higher odds of surviving 30 days (OR 2.7, 95 % CI 1.6, 4.6), lower probability of developing severe organ failure (0.7, 95 % CI 0.4, 0.9), and on average, 3.7 days (95 % CI 1.5, 5.9 days) shorter LOS than the pre-intervention group (n = 472).

Conclusions: In a cohort with stable mortality rates, early sepsis recognition by ward nurses may have reduced progression of disease and improved survival for patients in hospital with sepsis.

Keywords: Adherence; In-hospital; Sepsis; Survival; Systemic inflammatory response syndrome.

Fig. 1

Systemic inflammatory response syndrome (SIRS) and organ failure triage (SOF-Triage), which should be used for all inpatients with suspected infection, and clinical indication for monitoring. GCS Glasgow coma scale

Fig. 2

Nurses’ adherence to guidelines for each observation of vital signs (temperature, heart rate or respiratory frequency) during the 24 hours after drawing the first positive blood culture from patients with bloodstream infection (n = 881). Poor observation = 0–1 observation, some observations = 2–4 observations, and good observation = ≥5 observations. The post-intervention group had better observations of all vital signs in patients both with and without organ failure (χ² test: p ≤ 0.002 for all vital signs)