Purpose: To improve the values of multiple domains clinical protocols and the outcomes of adult surgical intensive care units (SICU) patients with triage using a simple and easy informatics tool.
Method: Design: A one-and- half-year period retrospective, before and after study. Setting: A 21-bed adult surgical intensive care unit of a 2700-bed medical center in Taipei. Patients: All consecutive patients admitted during the two study periods: the periods before, from Aug 2007 to Jan 2008, and after, from Aug 2008 to Jan 2009, intervention. Intervention: A multidisciplinary working group, including intensivists, surgeons, nurses etc., was organized before Aug 2007 to develop the checklists of 15 protocols according to the evidence-based published guidelines, such as surviving sepsis campaign guidelines. These protocols were liberally used in the first period. Between two study periods, the same group designed a paper-based triage-scale-like color coding system to screen patients (sepsis or non-sepsis) and to classify protocols into 4 categories: red, yellow, green, and white, requiring protocols to be completed within 1-6, 12, 24 and on-demand hours, respectively. This system was implemented in the second period after 3 months of education. Evaluation: The protocols compliance and SICU mortality rates were measured for comparison.
Result: There were 123 patients in the first period and 162 patients in the second one. There was no demographic difference among two groups. After adjusted possible confounders, such as age, APACHE 2 score, with logistic regression, there was a statistical significant decrease in mortalities among two groups from 39.02% (48/123) to 25.30% (41/162).( p=0.007) The compliance rate in the second period was lower, 36.41% (59/162), compared to that before the intervention, 43.08% (53/123). (p = 0.217)
Conclusion: The results showed that the effectiveness of using protocols in saving patients’ lives was significantly improved after the triage system was implemented. No other factor in these two periods could explain this difference. It was interesting to see that the compliance rate in the second period was lower (though no significant difference), which might be caused by lacking the reminder or a forceful audit system. We speculate that the effectiveness of protocols in saving people’s lives could be much higher after the triage system is computerized.
See more of: The 32nd Annual Meeting of the Society for Medical Decision Making