PURPOSE: To test the hypothesis that standardized, routine screening for SIRS criteria enhances detection of severe sepsis on medical and surgical units and in the emergency department(ED)of a university hospital.
METHODS: One medical and one surgical unit were targeted for the month-long trial. Training sessions were held for nurses on those units and in the ED to instruct them in identifying SIRS criteria and in filling out a standardized screening tool. All patients presenting to the ED with suspected infection were screened by the triage nurse. Screening occurred daily at 7 AM on the wards. Nurses were instructed to call the hospital’s rapid response team for assessment of organ dysfunction in any patient who a)had an acute infection and b)met 2 or more criteria for SIRS. Such screens were deemed positive. Nurses were also instructed to complete a screening tool for any patient admitted or diagnosed with acute infection. Following discharge and ICDN coding, charts of all screened patients were examined for sepsis related diagnoses.
RESULTS: 1,756 screens were performed on 1,060 patients. Of 3,050 total ED visits, 884 screens were performed on 865 patients. 91 ED screens were positive (10.3%). On the 2 nursing units 872 screens were performed on 265 patients. 10 of these screens were positive (1.1%). No rapid response calls were initiated for possible sepsis as a result of screening. Among the screened patients, 23 charts were coded for septicemia (ICD-9 038.9) and 11 for severe sepsis (ICD-9 995.92) at discharge. However, only 3 of these patients (8.8%) had screened positive, all in the ED.
CONCLUSION: Routine screening for infection with SIRS is neither efficient nor effective for identifying patients with severe sepsis. Screening of patients with suspected infection in the ED may be slightly more effective.
CLINICAL IMPLICATIONS: All clinical personnel should be trained to identify signs and symptoms of severe sepsis, but such skill is likely to be better applied to patients actively exhibiting them, rather than to the routine screening at a set time.
DISCLOSURE: Steven Simpson, None.