Research paper
The prevalence and triage characteristics of patients presenting with infection to one tertiary referral hospital

https://doi.org/10.1016/j.aenj.2012.06.001Get rights and content

Summary

Background

Globally, severe infection and or sepsis is a problem that is costing billions of dollars, using hundreds of hospital beds, and often results in patient death. Any infection can potentially develop a sepsis health trajectory if left unrecognised and unmanaged.

Methods

We conducted a 12 month retrospective descriptive exploratory study. Our research explored the prevalence and triage characteristics of patients presenting with infection to one tertiary referral hospital. Electronic medical records were reviewed to identify patients that had a primary diagnosis related to infection.

Results

The study identified that 16% (n = 7756) of adult presentations had a discharge diagnosis related to infection. A significant difference (X2 = 297.83, df = 4, p  .001) in Triage Code allocation for the infection group was identified compared with the non-infection patient group. Thirty-nine percent (n = 3027) of patients with infections were admitted to hospital. Of the patients (n = 1930; 4%) admitted to a critical care area, 6% (n = 122) had a primary diagnosis related to infection. Of the ED deaths (n = 81), 12% (n = 10) had a primary diagnosis related to infection.

Conclusion

The study provides a detailed analysis of the prevalence and triage characteristics of patients with infection presenting to one ED. Further research is needed to identify strategies to improve the triage nurse's recognition of severe infection and consistency of urgency code allocation to prevent patient deterioration.

Introduction

Globally, severe infection and or sepsis has been recognised as a major health issue.1, 2, 3 Sepsis remains one of the leading causes of hospital mortality and morbidity.4, 5 In Canada, in 2008–2009, 30,500 patients were admitted for sepsis, and over 30% (9300) of septic patients died.6 Similarly, in the United States 750,000 people develop sepsis annually and 40% of severe septic patients die.7, 8 Patients that survive sepsis often experience long term cognitive and functional disability.9

The early recognition and treatment of patients with severe infection can prevent deterioration and development of sepsis and or septic shock.10 Triage nurses are responsible for the initial assessment and allocation of an urgency Triage Code for all patients presenting to Australasian Emergency Departments (ED). Triage nurses make critical decisions every day that can determine how quickly a patient will be seen and subsequently managed by emergency staff.11 The triage nurse is well positioned to ensure the early recognition of severe infection and or sepsis and thereby improve timely management and patient survival.

Severe infection or development of sepsis needs to be recognised as a medical emergency. A recent Australian multi-centred study identified that 11.8 per one hundred admissions to Intensive Care Units (ICU) were associated with severe sepsis, with an in-hospital mortality rate of 37.5% increasing to 60% mortality for septic shock.12 Similarly, Sundarajan et al.,13 conducted a four year study, which identified a sepsis rate of 1.1% of overnight hospital admissions with a mortality rate of 18.4% and 23.8% of these patients requiring treatment in ICUs. While any infection can potentially develop into sepsis and septic shock14 there remains very little investigation into the prevalence and triage characteristics of ED patients presenting with infection. Therefore, our research aimed to explore the prevalence and triage characteristics of patients presenting with infection.

Section snippets

Methods

The 12 month (1st January–31st December 2010) retrospective descriptive exploratory study sought to determine the prevalence of adult patients (>16 years) presenting with an infection to one tertiary referral emergency department.

Results

The retrospective review identified an annual adult presentation rate of 47,814. Sixteen percent (n = 7756) of adult presentations involved an infection (Table 1). The majority (n = 6019; 77.6%) of these patients self-referred or walked into the ED, while 1717 (22.1%) patients arrived by ambulance, 18 (0.23%) by helicopter and 2 (0.02%) by police. Using the independent samples t-test there was no significant difference between infection and non-infection patient groups for age (t = 1.84, df = 4, p = 

Discussion

The study suggests that the prevalence of patients presenting with infection to one ED is substantial. The findings also suggest that admitted patients presenting with severe infections are intense users of hospital beds and resources given the hospital admission rate, use of critical care areas and operating rooms. In addition, patients with infection comprised a moderate proportion of ED patient deaths. Patients presenting with infection are a vulnerable group that require further

Limitations

There are several limitations to our study. The prevalence audit was conducted retrospectively and would best be confirmed by a multicentre prospective cohort study. The retrieving of ED data was reliant on clinicians’ willingness to complete all required documentation fields correctly. There may have been more than one patient diagnosis for the presentation but only the primary diagnosis was retrieved for the study. There may be a number of contributing factors that we did not look at that

Conclusions

We conducted a study to determine the prevalence and triage characteristics of patients presenting with infection related conditions to one ED. The study adds to the sepsis literature and supports the need for further research on ED management of this vulnerable patient group. Regular audits of patients presenting with infection could provide clinicians and managers with and a better understanding of service patterns, triage allocation and areas for improvement. Further research is needed to

Provenance and conflict of interest

There is no conflict of interest. This paper was not commissioned.

Funding source

This study was funded by a NSW Health Nursing and Midwifery Office Innovation Scholarship. We wish to acknowledge New South Wales Ministry of Health Nurses and Midwives Office for providing an innovation scholarship.

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