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Burdick, H., Pino, E., Gabel-Comeau, D., McCoy, A., Gu, C., Roberts, J., Le, S., Slote, J., Pellegrini, E., Green-Saxena, A., Hoffman, J., & Das, R. (2020, February 14). Effect of a sepsis prediction algorithm on patient mortality, length of stay and readmission: a prospective multicentre clinical outcomes evaluation of real-world patient data from US hospitals. BMJ Journals. Retrieved September 17, 2020, from https://informatics.bmj.com/content/27/1/e100109

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Burney, Mara, et al. (2012). Early Detection and Treatment of Severe Sepsis in the Emergency Department: Identifying Barriers to Implementation of a Protocol-Based Approach. Journal of Emergency Nursing, 38(6), 512-517. http://dx.doi.org.ju.idm.oclc.org/10.1016/j.jen.2011.08.011

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How can I get ahead of Sepsis. (2020, September 1). Centers for Disease Control and Prevention. https://www.cdc.gov/sepsis/prevention/index.html

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-Many studies address the importance of early sepsis detection to decrease ICU admissions and mortality.
-The approach used to detect early sepsis requires education, training, multidisciplinary collaboration, and proper treatment protocols/tools, i.e., sepsis bundle

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-Lactate lab (done before antibiotic administration)
-blood culture (done before antibiotic administration)
-antibiotic administration
-IV fluids

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Pruinelli, L., Westra, B. L., Yadav, P., Hoff, A., Steinbach, M., Kumar, V., Delaney, C. W., & Simon, G. (2018). Delay within the 3-hour surviving sepsis campaign guideline on mortality for patients with severe sepsis and septic shock. HHS Public Access. Retrieved September 28, 2020, from https://doi.org/0.1097/CCM.0000000000002949

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Perceived greatest cause of delay in the treatment of severe sepsis/septic shock are:
-Delay in diagnosis of sepsis by physicians
-Delay in availability of ICU beds
-Lack of recognition in triage
-Knowledge deficit regarding appropriate management
-Nursing delays (eg. Time to completion of orders)
-Laboratory delays
-Pharmacy delays
-Lack of necessary equipment

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In emergency room patients, how does early detection of sepsis, compared to delayed detection of sepsis, affect reducing intensive care unit (ICU) admissions and morbidity?

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Threatt, D. L. (2020). Improving Sepsis Bundle Implementation Times: A Nursing Process Improvement Approach. Journal of Nursing Care Quality, 35(2), 135–139. https://doi-org.ju.idm.oclc.org/10.1097/NCQ.0000000000000430

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"Deliberate Nursing Process Theory"

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The databases used to search for information regarding sepsis treatments were CINAHL Complete, Ovid Full-Text Nursing,  Centers for Disease Control and Prevention (CDC), American Family Physician Journal (AFP),  International Journal of Emergency Medicine, Journal of Nursing Care Quality, BioMed Central, National Institute of Health (NIH), and National Center for Biotechnology Information (NCBI). The keywords searched on were “sepsis,” “severe sepsis,” “septic shock,” ‘infection,”  “emergency department,” “mortality,” “sepsis bundle,” “ICU admissions,” “outcomes,” “detection,” “timing,” and “admissions.”

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Filters used to simplify search included  PDF full text, peer-review,  English language, and time range from 2012-2020.

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The searched studies ranged in Level of evidence from III to IV.

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-Sepsis is difficult to stay ahead of due to the fact it is so hard to diagnose in the emergency department.
-Ways to help prevent infections from manifesting into sepsis is to prevent infections, practice good hygiene, know the signs of sepsis, and act swiftly when signs and symptoms arise (CDC, 2020).
-Implementation of a clinical sepsis tool in the emergency department has proven to decrease mortality rates (Threatt, 2020).
-Intensive care units' inability to provide beds for septic patients quickly enough to continue treatment is a setback for patient outcomes.

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by Surviving Sepsis Campaign (SSC)

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Deliberative Nursing Process Theory emphasizes the reciprocal relationship between the patient and the nurse and the nurse's role in meeting the patient's immediate need. (Gonzalo, 2019)

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In utilizing Orlando's theoretical framework there could be an earlier detection and intervention of sepsis which could improve patient outcomes by meeting their immediate needs.

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Sepsis is a life threatening condition that occurs when an infection you already have, triggers a chain reaction and begins to damage tissues and bodily organs.  Sepsis was diagnosed in 1.7 million people nationwide, and is responsible for 270, 000 deaths (CDC 2020).

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What is Sepsis. (2020, August 27). Centers for Disease Control and Prevention. https://www.cdc.gov/sepsis/what-is-sepsis.html

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In the Emergency Department (ED), quality sepsis care is delivered when there is valid triaging, addressing the source of infection, administering antibiotics and fluid resuscitation early (Wuthisuthimethawee, P, 2019).

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Wuthisuthimethawee, P. W. (2019, April 11). Septic Shock in the ER. National Institute of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489668/

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As technology in healthcare continues to advance, newer methods have been developed to monitor a patient’s electronic health record (EHR) for data related to severe sepsis in an attempt to recognize the signs and symptoms of the diagnosis earlier and implement treatment accordingly (Burdick et al., 2020). While few of these methods have been proven to have predictive capabilities, machine learning algorithms (MLAs) have the potential to improve overall patient outcomes with advanced warnings of possible sepsis onset (Burdick et al., 2020).

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-Sepsis has a massive effect on the healthcare system and the costs associated with treating it.
-In 2008, sepsis accounted for nearly 5.2% of hospital expenditure, at a cost of $20 billion, with over 1 million persons hospitalized (Pruinelli et al., 2018).

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In conclusion, there are numerous research studies to discover the early detection and management of sepsis. It has been proven on several occasions that early detection of sepsis in the ED significantly reduces ICU admissions and patient morbidity and mortality. Initial acknowledgment is a vital point of the entire management of sepsis because it allows for prompt treatment. This ultimately improves survival, thus decreasing mortality and morbidity in individuals. The worldwide estimated incidence is 270 cases per 100,000 inhabitants/year, and the mortality rate ranges between 20 and 40% (Emanuela et al., 2019). The effects of both hospital policies and protocols and alert systems have decreased the number of mortality in patients. Two of the main factors that are introduced in research articles are hospital cost and patient mortality. Sepsis is responsible for more than one-third of all hospital admissions, and it is associated with an enormous financial burden on healthcare (Emanuela et al., 2019). This research paper has demonstrated numerous articles that provide comprehensive data in early detection tools and prognosis data, like EHR alert systems, high lactate, and albumin levels, and sepsis bundles, include rapid recognition and management protocols in ED, including blood cultures, fluid resuscitation, and early broad-spectrum antibiotic therapy (Burney et al., 2012). Further studies of interest should aim to reduce selection limitations in sepsis progression programs, perform research at multiple organizations, and incorporate screening tools in EHR systems. Similarly, missed opportunities for identification in triage and a delay in physicians' diagnosis were among the most commonly cited barriers.

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This is a short summarization of the information befor you. Enjoy!