Journal for healthcare quality : official publication of the National Association for Healthcare Quality
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Early identification of septic patients is important to prevent delays in appropriate management. To improve detection of septic patients presenting to the emergency department (ED), we implemented a triage screening tool. Our study sought to determine the effect of this tool on time to antibiotics in patients with suspected severe sepsis or septic shock presenting to the ED. ⋯ The mean time (in minutes) to antibiotics (±SD) in the pre- and postcohorts was 283 (±213) and 207 (±150), respectively. The multivariable analysis showed that the mean time to antibiotics decreased by 21% (95% CI 6-36%, p < .0074) comparing pre- versus posttriage tool implementation. The use of a sepsis triage screening tool significantly decreased the time to antibiotics in patients presenting to the ED with suspected severe sepsis or septic shock.
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The objective was to evaluate the analysis of adverse events and the decisions for quality improvement decided during morbidity and mortality conferences (MMCs). We conducted a prospective observational study of MMCs conducted in a teaching hospital between November 2007 and May 2008. Two observers attended the conferences and collected data on the structure of MMCs, the discussion between attendees, and the decisions or actions for quality improvement. ⋯ An analysis of underlying factors contributing to these shortcomings was observed in 75% of cases, with 4% considered structured and thorough. Eighty-five decisions or actions to improve quality of care or patient safety were listed, with 28 of them (33%) planned for implementation. Discussion of adverse events appears to lack a structured method and although a large number of decisions for quality improvement were declared, fewer actions were planned with a timeline.