Implementación de una estrategia en formato código para mejorar el manejo de la sepsis grave comunitaria en hospitales comarcales sin UCI

Abstract

Introduction: Community severe sepsis is a highly fatal disease that increases its incidence every year and involves great coordination of different areas by the variety of forms of presentation and resources that may be required for diagnosis and treatment. They have made great efforts to streamline and standardize their management, using strategies like Early Goal Directed therapy, recommendations or packages (bundles) Surviving Sepsis Campaign (SSC). The peculiarities of the Catalan health system could hinder the implementation of the guidelines and the continuum of care in its handling by the existence of numerous regional centers without intensive care units . Other life-threatening diseases have managed to identify the maneuvers essential for the stabilization and optimization of the code which could be extrapolated format. Objective: To implement a strategy in code format that reduces the lethality of these patients at community hospital without UCI. Methods: A before and after a training strategy to improve adherence to existing clinical guidelines in a community hospital. Results: The incidence of 1'4 - 1'5 per 1000 / year is estimated. Adherence to the SSC bundles in regional hospitals is less than 1%, achieving an improvement of up to 18'3 % after the implementation of the code. The lethality of the process is a 20'6 % decreasing to 13'3 % in patients without limitation of therapeutic effort. The Charlson index, age, SOFA score and the administration of vasoactive drugs are associated with increased mortality. The administration of antibiotics in the shortest time possible, the identification of patients at high risk (comorbidity and/or severity of presentation) and moving to more complex centers, are associated with longer survival. Conclusions: The overall incidence of SS / SG is high compared with other life-threatening diseases. Adherence to the guidelines proposed by the SSC is low and can be improved with training strategies and interhospital coordination between the institutions involved.

Date of Award	28 Nov 2014
Original language	Spanish
Supervisor	Juan Carlos Yebenes Reyes (Director)