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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 28 Research Studies DisplayedAnesi GL, Chelluri J, Qasim ZA
Association of an emergency department-embedded critical care unit with hospital outcomes and intensive care unit use.
The purpose of this study was to evaluate the potential impact of an emergency department-embedded critical care unit (CCU) at the Hospital of the University of Pennsylvania among patients with sepsis and acute respiratory failure (ARF) admitted from the emergency department to a medical ward or ICU from January 2016 to December 2017. Findings showed that the emergency department-embedded CCU was not associated with clinical outcomes among patients admitted with sepsis or ARF. Among less sick patients with sepsis, the emergency department-embedded CCU was initially associated with reduced rates of direct ICU admission from the emergency department. Further research was recommended to further evaluate the impact and utility of the emergency department-embedded CCU model.
AHRQ-funded; HS026372.
Citation: Anesi GL, Chelluri J, Qasim ZA .
Association of an emergency department-embedded critical care unit with hospital outcomes and intensive care unit use.
Ann Am Thorac Soc 2020 Dec;17(12):1599-609. doi: 10.1513/AnnalsATS.201912-912OC..
Keywords: Emergency Department, Critical Care, Intensive Care Unit (ICU), Hospitals, Sepsis, Respiratory Conditions, Outcomes, Patient-Centered Outcomes Research, Healthcare Delivery
Shappell CN, Klompas M, Rhee C
Does severe acute respiratory syndrome coronavirus 2 cause sepsis?
Although some experts have unequivocally asserted that multiple organ failure arising from COVID-19 is sepsis, other case series of severe COVID-19 infections have not labeled the disease as sepsis despite the fact that patients have proven infection and organ dysfunction and therefore meet the formal definition of sepsis. In this study, the authors explore why this is the case, and whether or not it truly serves patients.
AHRQ-funded; HS025008.
Citation: Shappell CN, Klompas M, Rhee C .
Does severe acute respiratory syndrome coronavirus 2 cause sepsis?
Crit Care Med 2020 Dec;48(12):1707-09. doi: 10.1097/ccm.0000000000004601..
Keywords: COVID-19, Sepsis, Respiratory Conditions
Jordan Kempker A, Rudd KE, Wang HE
https://www.pubmed.ncbi.nlm.nih.gov/33009097
Sepsis epidemiology across the International Classification of Diseases, 9th Edition, to International Classification of Diseases, 10th Edition, chasm-a direct application of the Institute for Health Metrics and Evaluation case definition to hospital disc
The objective of this study was to describe the epidemiology of sepsis across the transition from the International Classification of Diseases (ICD), 9th Edition and ICD, 10th Edition, coding systems, evaluating estimates of two previously published ICD 10th Edition, coding strategies. The investigators concluded that The Institute for Health Metrics and Evaluation ICD, 10th Edition, coding strategy for identifying sepsis may capture a larger patient population within administrative datasets that are different from those identified with previously deployed ICD-based methods.
Citation: Jordan Kempker A, Rudd KE, Wang HE .
Sepsis epidemiology across the International Classification of Diseases, 9th Edition, to International Classification of Diseases, 10th Edition, chasm-a direct application of the Institute for Health Metrics and Evaluation case definition to hospital disc
Crit Care Med 2020 Dec;48(12):1881-84. doi: 10.1097/ccm.0000000000004577..
Keywords: Healthcare Cost and Utilization Project (HCUP), Sepsis, Diagnostic Safety and Quality
Mohr NM, Pape SG, Runde D
Etomidate use is associated with less hypotension than ketamine for emergency department sepsis intubations: a NEAR cohort study.
The objectives of this study were to describe the current use of etomidate and other induction agents in patients with sepsis and to compare adverse events between etomidate and ketamine in sepsis. Using the National Emergency Airway Registry data set, findings showed that etomidate is used less frequently in sepsis patients than in non-sepsis patients, with ketamine being the most frequently used alternative. Further, ketamine was associated with more postprocedural hypotension than etomidate. Recommendations included future clinical trials to determine the optimal induction agent in patients with sepsis.
AHRQ-funded; HS025753.
Citation: Mohr NM, Pape SG, Runde D .
Etomidate use is associated with less hypotension than ketamine for emergency department sepsis intubations: a NEAR cohort study.
Acad Emerg Med 2020 Nov;27(11):1140-49. doi: 10.1111/acem.14070..
Keywords: Medication, Sepsis, Emergency Department, Registries, Adverse Drug Events (ADE), Adverse Events
Mohr NM, Zebrowski AM, Gaieski DF
Inpatient hospital performance is associated with post-discharge sepsis mortality.
The objective of this study was to test the hypothesis that hospitals with high risk-adjusted inpatient sepsis mortality also have high post-discharge mortality, readmissions, and discharge to nursing homes. Sepsis hospitalization survivors among age-qualifying Medicare beneficiaries were followed for 180 days post-discharge; mortality, readmissions, and new admission to skilled nursing facilities were measured. Findings showed that hospitals with the highest risk-adjusted sepsis inpatient mortality also had higher post-discharge mortality and increased readmissions, suggesting that post-discharge complications were a modifiable risk that may be affected during inpatient care. Recommendations for future work include seeking to elucidate inpatient and healthcare practices that can reduce sepsis post-discharge complications.
AHRQ-funded; HS023614; HS025753.
Citation: Mohr NM, Zebrowski AM, Gaieski DF .
Inpatient hospital performance is associated with post-discharge sepsis mortality.
Crit Care 2020 Oct 27;24(1):626. doi: 10.1186/s13054-020-03341-3..
Keywords: Sepsis, Mortality, Hospital Discharge, Hospitals, Provider Performance, Quality of Care, Inpatient Care, Hospital Readmissions
Slatnick LR, Thornhill D, Deakyne Davies
Disseminated intravascular coagulation is an independent predictor of adverse outcomes in children in the emergency department with suspected sepsis.
The purpose of this study was to evaluate the impact of early disseminated intravascular coagulation (DIC) on illness severity in children using a database of emergency department ED encounters for children with suspected sepsis, in view of similar associations in adults. The investigators concluded that a DIC score of ≥3 was an independent predictor for both vasopressor use and mortality in this pediatric cohort, distinct from the adult overt DIC score cutoff of ≥5.
AHRQ-funded; HS025696.
Citation: Slatnick LR, Thornhill D, Deakyne Davies .
Disseminated intravascular coagulation is an independent predictor of adverse outcomes in children in the emergency department with suspected sepsis.
J Pediatr 2020 Oct;225:198-206.e2. doi: 10.1016/j.jpeds.2020.06.022..
Keywords: Children/Adolescents, Emergency Department, Sepsis, Adverse Events, Mortality, Patient Safety, Outcomes
Bourne DS, Davis BS, Gigli KH
Economic analysis of mandated protocolized sepsis care in New York hospitals.
Investigators evaluated the effects of the 2013 New York State sepsis regulations on the costs of care for patients hospitalized with sepsis. They found that mandated protocolized sepsis care was not associated with significant changes in hospital costs in patients hospitalized with sepsis in New York State.
AHRQ-funded; HS025146.
Citation: Bourne DS, Davis BS, Gigli KH .
Economic analysis of mandated protocolized sepsis care in New York hospitals.
Crit Care Med 2020 Oct;48(10):1411-18. doi: 10.1097/ccm.0000000000004514..
Keywords: Healthcare Cost and Utilization Project (HCUP), Sepsis, Healthcare Costs, Hospitalization, Hospitals
Scott HF, Brilli RJ, Paul R
Evaluating pediatric sepsis definitions designed for electronic health record extraction and multicenter quality improvement.
The purpose of this study was to describe the Children's Hospital Association's Improving Pediatric Sepsis Outcomes sepsis definitions and to evaluate the definition using a published framework. The investigators concluded that the Improving Pediatric Sepsis Outcomes Sepsis definitions demonstrated feasibility for large-scale data abstraction. When operationalized, these definitions enabled multicenter identification and data aggregation, indicating practical utility for quality improvement.
AHRQ-funded; HS025696.
Citation: Scott HF, Brilli RJ, Paul R .
Evaluating pediatric sepsis definitions designed for electronic health record extraction and multicenter quality improvement.
Crit Care Med 2020 Oct;48(10):e916-e26. doi: 10.1097/ccm.0000000000004505..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Sepsis, Quality Improvement, Quality of Care
Gale BM, Hall KK
The use of patient monitoring systems to improve sepsis recognition and outcomes: a systematic review.
This systematic review’s aim was to determine the impact of automated patient monitoring systems (PMSs) on sepsis recognition and outcomes. The review was conducted using articles published from 2008 through 2018. Nineteen articles were identified for inclusion with 4 systematic reviews and 15 individual studies. Study results for outcome measures were mixed, with more than half the studies showing a significant improvement in at least one outcome measure (eg mortality, intensive care unit length of stay, ICU transfer). Evidence for process measure improvement was of moderate strength across multiple hospital units.
AHRQ-funded; 233201500013I.
Citation: Gale BM, Hall KK .
The use of patient monitoring systems to improve sepsis recognition and outcomes: a systematic review.
J Patient Saf 2020 Sep;16(3S Suppl 1):S8-s11. doi: 10.1097/pts.0000000000000750..
Keywords: Clinical Decision Support (CDS), Sepsis, Diagnostic Safety and Quality, Screening, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Schafer R, Phillippi JC
Group B streptococcal bacteriuria in pregnancy: an evidence-based, patient-centered approach to care.
Screening and management of group B streptococcus (GBS) bacteriuria in pregnancy aims to reduce the incidence of pyelonephritis and GBS-related neonatal morbidity and mortality. This article used a case study approach to discuss evidence-based, patient-centered care for group B streptococcal bacteriuria in pregnancy as well as ethical incorporation of individual patient preferences and values.
AHRQ-funded; HS024733.
Citation: Schafer R, Phillippi JC .
Group B streptococcal bacteriuria in pregnancy: an evidence-based, patient-centered approach to care.
J Midwifery Womens Health 2020 May;65(3):376-81. doi: 10.1111/jmwh.13085..
Keywords: Infectious Diseases, Pregnancy, Women, Patient-Centered Healthcare, Evidence-Based Practice, Newborns/Infants, Sepsis, Case Study
Shappell CN, Klompas M, Rhee C
Surveillance strategies for tracking sepsis incidence and outcomes.
Sepsis is a leading cause of death and the target of intense efforts to improve recognition, management and outcomes. Accurate sepsis surveillance is essential to properly interpreting the impact of quality improvement initiatives, making meaningful comparisons across hospitals and geographic regions, and guiding future research and resource investments. In this review, the investigators discuss the advantages and limitations of different sepsis surveillance strategies and consider future directions.
AHRQ-funded; HS025008.
Citation: Shappell CN, Klompas M, Rhee C .
Surveillance strategies for tracking sepsis incidence and outcomes.
J Infect Dis 2020 Jul 21;222(Suppl 2):S74-s83. doi: 10.1093/infdis/jiaa102..
Keywords: Sepsis, Outcomes, Quality Improvement, Quality of Care
Gigli KH, Davis BS, Yabes JG
Pediatric outcomes after regulatory mandates for sepsis care.
The authors used hospital discharge data from 2011 to 2015 to compare changes in pediatric sepsis outcomes in New York and four control states following New York’s 2013 regulations mandating that hospitals develop pediatric-specific protocols for sepsis recognition and treatment. They found that implementation of statewide sepsis regulations was generally associated with improved mortality trends in New York State, particularly in prespecified subpopulations of patients, suggesting that the regulations were successful in affecting sepsis outcomes.
AHRQ-funded; HS025146.
Citation: Gigli KH, Davis BS, Yabes JG .
Pediatric outcomes after regulatory mandates for sepsis care.
Pediatrics 2020 Jul;146(1). doi: 10.1542/peds.2019-3353.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Sepsis, Outcomes, Hospitals
Lindell RB, Nishisaki A, Weiss SL
Risk of mortality in immunocompromised children with severe sepsis and septic shock.
This study’s objective was to assess the risk of mortality for immunocompromised children admitted to the hospital with septic shock or sepsis. This retrospective multicenter cohort study used eighty-three centers in the Virtual Pediatric systems database. The cohort included children admitted to the pediatric intensive care unit (PICU) with severe sepsis or septic shock from 2012-2016. Across 83 centers, 10,768 PICU admissions with an International Classification of Diseases, 9th Revision, Clinical Modification code for severe sepsis or septic shock were identified; with 3,021 of these patients (28%) having an immunocompromised diagnosis. PICU mortality rates varied widely by center, and those centers with a higher mean number of sepsis patients per month in a center had a lower PICU mortality rate. Multiple prior malignancies, hemophagocytic lymphohistiocytosis, congenital immunodeficiency, and hematopoietic cell transplant are conditions independently associated with an increased odds of PICU mortality in children with severe sepsis or septic shock.
AHRQ-funded; HS024511; HS026939; HS021583; HS022464.
Citation: Lindell RB, Nishisaki A, Weiss SL .
Risk of mortality in immunocompromised children with severe sepsis and septic shock.
Crit Care Med 2020 Jul;48(7):1026-33. doi: 10.1097/ccm.0000000000004329..
Keywords: Children/Adolescents, Mortality, Sepsis, Risk, Intensive Care Unit (ICU), Hospitalization, Hospitals
Adelman MW, Woodworth MH, Langelier C
The gut microbiome's role in the development, maintenance, and outcomes of sepsis.
This paper examines the gut microbiome’s role in the development, maintenance and outcomes of sepsis. The authors focus on the key three areas of the interaction between the gut microbiome and sepsis and how once sepsis is established the gut microbiome worsens and increases susceptibility to end-organ dysfunction. They outline a potential research agenda for further investigating the interaction between the gut microbiome and sepsis.
AHRQ-funded; HS025240.
Citation: Adelman MW, Woodworth MH, Langelier C .
The gut microbiome's role in the development, maintenance, and outcomes of sepsis.
Crit Care 2020 Jun 1;24(1):278. doi: 10.1186/s13054-020-02989-1..
Keywords: Digestive Disease and Health, Sepsis
Arulraja MD, Swanson MB, NM
Double inter-hospital transfer in sepsis patients presenting to the ED does not worsen mortality compared to single inter-hospital transfer.
This study investigated whether double inter-hospital transfer in sepsis patients presenting to the emergency department (ED) worsens mortality compared to single inter-hospital transfer. A retrospective cohort study was conducted using 2005-2014 administrative claims data in Iowa. Hospital length-of-stay and cost data was also collected. Compared to non-transfers, single transfers did not have higher mortality rates than double transfers of Iowa sepsis patients.
AHRQ-funded; HS025753.
Citation: Arulraja MD, Swanson MB, NM .
Double inter-hospital transfer in sepsis patients presenting to the ED does not worsen mortality compared to single inter-hospital transfer.
J Crit Care 2020 Apr;56:49-57. doi: 10.1016/j.jcrc.2019.11.018..
Keywords: Sepsis, Transitions of Care, Mortality, Hospitals, Emergency Department, Outcomes
Cooper AJ, Keller SP, Chan C
Improvements in sepsis-associated mortality in hospitalized patients with cancer versus those without cancer. a 12-year analysis using clinical data.
The goal of this study was to assess trends in sepsis-associated mortality in hospitalized patients with and without cancer using objective clinical criteria to identify sepsis and detailed clinical data to adjust for severity of illness. Findings showed that sepsis-associated mortality rates declined significantly over a 12-year period in patients with cancer, but not in patients without cancer. Potential explanations include advances in the management of cancer and/or better sepsis treatments specifically in patients with cancer.
AHRQ-funded; HS025008.
Citation: Cooper AJ, Keller SP, Chan C .
Improvements in sepsis-associated mortality in hospitalized patients with cancer versus those without cancer. a 12-year analysis using clinical data.
Ann Am Thorac Soc 2020 Apr;17(4):466-73. doi: 10.1513/AnnalsATS.201909-655OC..
Keywords: Sepsis, Mortality, Cancer, Hospitalization, Outcomes
Rhee C, Kadri SS, Dekker JP
Prevalence of antibiotic-resistant pathogens in culture-proven sepsis and outcomes associated with inadequate and broad-spectrum empiric antibiotic use.
Broad-spectrum antibiotics are recommended for all patients with suspected sepsis to minimize the risk of undertreatment. However, little is known regarding the net prevalence of antibiotic-resistant pathogens across all patients with community-onset sepsis or the outcomes associated with unnecessarily broad empiric treatment. The purpose of this study was to elucidate the epidemiology of antibiotic-resistant pathogens and the outcomes associated with both undertreatment and overtreatment in patients with culture-positive community-onset sepsis.
AHRQ-funded; HS025008.
Citation: Rhee C, Kadri SS, Dekker JP .
Prevalence of antibiotic-resistant pathogens in culture-proven sepsis and outcomes associated with inadequate and broad-spectrum empiric antibiotic use.
JAMA Netw Open 2020 Apr;3(4):e202899. doi: 10.1001/jamanetworkopen.2020.2899.
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Keywords: Antibiotics, Medication, Sepsis, Outcomes
Klompas M, Osborn TM, Rhee C
Who owns sepsis?
In this Ideas and Opinions article, the authors discuss applying to sepsis guidelines that are already in place for other conditions. They indicate that other time-critical diagnoses have evolved triaging systems to inform the urgency and intensity of therapy, and that sepsis can evolve similarly, where potentially infected patients with worrisome signs or comorbidities, such as hypotension, altered mental status, or immunosuppression, are managed with one level of urgency and intensity and less severely ill patients are managed with another.
AHRQ-funded; HS025008.
Citation: Klompas M, Osborn TM, Rhee C .
Who owns sepsis?
Ann Intern Med 2020 Feb 4;172(3):210-11. doi: 10.7326/m19-2966..
Keywords: Sepsis, Guidelines, Diagnostic Safety and Quality, Critical Care
Scott HF, Colborn KL, Sevick CJ
Development and validation of a predictive model of the risk of pediatric septic shock using data known at the time of hospital arrival.
The purpose of this observational cohort study was to derive and validate a model of risk of septic shock among children with suspected sepsis, using data known in the electronic health record at hospital arrival. The investigators concluded that their model estimated the risk of septic shock in children at hospital arrival earlier than existing models. They indicate it leveraged the predictive value of routine electronic health record data through a modern predictive algorithm and suggest it has the potential to enhance clinical risk stratification in the critical moments before deterioration.
AHRQ-funded; HS025696.
Citation: Scott HF, Colborn KL, Sevick CJ .
Development and validation of a predictive model of the risk of pediatric septic shock using data known at the time of hospital arrival.
J Pediatr 2020 Feb;217:145-51.e6. doi: 10.1016/j.jpeds.2019.09.079..
Keywords: Children/Adolescents, Sepsis, Emergency Department, Hospitals, Risk, Electronic Health Records (EHRs), Health Information Technology (HIT)
Gurigis FW, Donnelly JP, Dodani S
Cholesterol levels and long-term rates of community-acquired sepsis.
The researchers sought to determine the relationship between baseline cholesterol levels and long-term rates of sepsis. They found that low low-density lipoprotein cholesterol (LDL-C) was associated with higher long-terms rates of community-acquired sepsis. High-density lipoprotein cholesterol (HDL-C) level was not associated with long-term sepsis rates.
AHRQ-funded; HS013852.
Citation: Gurigis FW, Donnelly JP, Dodani S .
Cholesterol levels and long-term rates of community-acquired sepsis.
Crit Care 2016 Dec 23;20(1):408. doi: 10.1186/s13054-016-1579-8.
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Keywords: Heart Disease and Health, Community-Acquired Infections, Sepsis
Wheeler DS, Wong HR
Sepsis in pediatric cardiac intensive care.
The authors reviewed risk factors for developing sepsis; the role of biomarkers; and the pathophysiology and management of severe sepsis and septic shock. They concluded that while scientific advances in the diagnosis and clinical staging of sepsis offer tremendous promise for the future, it is also evident that sepsis mortality has not improved enough, even with progress in our understanding of the molecular pathophysiology of sepsis.
AHRQ-funded; HS020455.
Citation: Wheeler DS, Wong HR .
Sepsis in pediatric cardiac intensive care.
Pediatr Crit Care Med 2016 Aug;17(8 Suppl 1):S266-71. doi: 10.1097/pcc.0000000000000796.
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Keywords: Cardiovascular Conditions, Children/Adolescents, Intensive Care Unit (ICU), Children/Adolescents, Sepsis
Donnelly JP, Locke JE, MacLennan PA
Inpatient mortality among solid organ transplant recipients hospitalized for sepsis and severe sepsis.
The researchers investigated the impact of solid organ transplant (SOT) on outcomes following sepsis. They found that among patients hospitalized for severe sepsis or sepsis, those with SOT had lower inpatient mortality than those without SOT.
AHRQ-funded; HS013852.
Citation: Donnelly JP, Locke JE, MacLennan PA .
Inpatient mortality among solid organ transplant recipients hospitalized for sepsis and severe sepsis.
Clin Infect Dis 2016 Jul 15;63(2):186-94. doi: 10.1093/cid/ciw295.
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Keywords: Transplantation, Mortality, Sepsis, Hospitalization, Patient-Centered Outcomes Research
Moore JX, Donnelly JP, Griffin R
Defining sepsis mortality clusters in the United States.
The researchers aimed to identify US counties with high sepsis mortality and to assess the community characteristics associated with increased sepsis mortality. They found that sepsis mortality is higher in the southern United States and that regions of high sepsis mortality are characterized by lower education, income, employment, and insurance coverage.
AHRQ-funded; HS013852.
Citation: Moore JX, Donnelly JP, Griffin R .
Defining sepsis mortality clusters in the United States.
Crit Care Med 2016 Jul;44(7):1380-7. doi: 10.1097/ccm.0000000000001665.
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Keywords: Mortality, Sepsis, Social Determinants of Health
Wang HE, Donnelly JP, Griffin R
Derivation of novel risk prediction scores for community-acquired sepsis and severe sepsis.
The researchers derived and internally validated a Sepsis Risk Score and a Severe Sepsis Risk Score predicting future sepsis and severe sepsis events among community-dwelling adults. They concluded that the Sepsis Risk Score and Severe Sepsis Risk Score predict 10-year sepsis and severe sepsis risk among community-dwelling adults and may aid in sepsis prevention or mitigation efforts.
AHRQ-funded; HS013852.
Citation: Wang HE, Donnelly JP, Griffin R .
Derivation of novel risk prediction scores for community-acquired sepsis and severe sepsis.
Crit Care Med 2016 Jul;44(7):1285-94. doi: 10.1097/ccm.0000000000001666.
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Keywords: Community-Acquired Infections, Risk, Risk, Sepsis
Harrison AM, Gajic O, Pickering BW
Development and implementation of sepsis alert systems.
Development and implementation of sepsis alert systems is challenging, particularly outside the monitored intensive care unit (ICU) setting. Current evidence does not support routine use of sepsis alert systems in clinical practice. Continuous improvement in the afferent and efferent aspects will help translate theoretic advantages into measurable patient benefit.
AHRQ-funded; HS022799.
Citation: Harrison AM, Gajic O, Pickering BW .
Development and implementation of sepsis alert systems.
Clin Chest Med 2016 Jun;37(2):219-29. doi: 10.1016/j.ccm.2016.01.004..
Keywords: Intensive Care Unit (ICU), Sepsis, Outcomes, Adverse Events