BACKGROUND In 2013, New York began requiring hospitals to follow protocols for the early identification and treatment of sepsis. However, there is controversy about whether more rapid treatment of sepsis improves outcomes in patients. METHODS We studied data from patients with sepsis and septic shock that were reported to the New York State Department of Health from April 1, 2014, to June 30, 2016. Patients had a sepsis protocol initiated within 6 hours after arrival in the emergency department and had all items in a 3‐hour bundle of care for patients with sepsis (i.e., blood cultures, broad‐spectrum antibiotic agents, and lactate measurement) completed within 12 hours. Multilevel models were used to assess the associations between the time until completion of the 3‐hour bundle and risk‐adjusted mortality. We also examined the times to the administration of antibiotics and to the completion of an initial bolus of intravenous fluid. RESULTS Among 49,331 patients at 149 hospitals, 40,696 (82.5%) had the 3‐hour bundle completed within 3 hours. The median time to completion of the 3‐hour bundle was 1.30 hours (interquartile range, 0.65 to 2.35), the median time to the administration of antibiotics was 0.95 hours (interquartile range, 0.35 to 1.95), and the median time to completion of the fluid bolus was 2.56 hours (interquartile range, 1.33 to 4.20). Among patients who had the 3‐hour bundle completed within 12 hours, a longer time to the completion of the bundle was associated with higher risk‐adjusted in‐hospital mortality (odds ratio, 1.04 per hour; 95% confidence interval [CI], 1.02 to 1.05; P<0.001), as was a longer time to the administration of antibiotics (odds ratio, 1.04 per hour; 95% CI, 1.03 to 1.06; P<0.001) but not a longer time to the completion of a bolus of intravenous fluids (odds ratio, 1.01 per hour; 95% CI, 0.99 to 1.02; P=0.21). CONCLUSIONS More rapid completion of a 3‐hour bundle of sepsis care and rapid administration of antibiotics, but not rapid completion of an initial bolus of intravenous fluids, were associated with lower risk‐adjusted in‐hospital mortality. (Funded by the National Institutes of Health and others.)

Supplement to: Time to treatment and mortality during mandated emergency care for sepsis.

Introduction Some major changes have occurred in emergency department (ED) organization since the early 2000s, such as the establishment of triage nurses and short-track systems. The objectives of this study were to describe the characteristics of French EDs organization and users, based on a nationwide cross-sectional survey. Methods The French Emergency Survey was a nationwide cross-sectional survey. All patients presenting to all EDs during a 24-hr period of June 2013 were included. Data collection concerned ED characteristics as well as patient characteristics. Results Among the 736 EDs in France, 734 were surveyed. Triage nurses and short-track systems were respectively implemented in 73% and 41% of general EDs. The median proportion of patients aged > 75 years was 14% and median hospitalisation rate was 20%. During the study period, 48,711 patients presented to one of the 734 EDs surveyed. Among them, 7% reported having no supplementary health or universal coverage (for people with lower incomes). Overall, 50% of adult patients had been seen by the triage nurse in less than 5 minutes, 74% had a time to first medical contact shorter than one hour and 55% had an ED length of stay shorter than 3 hours. Conclusion The French Emergency Survey is the first study to provide data on almost all EDs in France. It underlines how ED organization has been redesigned to face the increase in the annual census. French EDs appear to have a particular role for vulnerable people: age-related vulnerability and socio-economic vulnerability with an over-representation of patients without complementary health coverage.

/pdf/the-french-emergency-national-survey-a-description-of-1e0zs1gc60.pdf

The French Emergency National Survey: A description of emergency departments and patients in France

La Societe francaise de medecine d’urgence (SFMU) a recommande la creation d’une echelle specifique, unique au niveau national, pour le triage des patients a l’accueil d’une structure d’urgences, prenant en compte les specificites de l’adulte et de l’enfant. La commission de l’evaluation et de la qualite de la SFMU a cree, a l’instar des echelles de tri internationales, une echelle de tri avec cinq niveaux de priorite croissante (tris 5 a 1, du moins urgent au plus urgent) auxquels correspondent des motifs de recours aux soins de complexite/severite croissante. Le tri 3 a ete subdivise en deux groupes pour distinguer (et prioriser) les patients qui ont au moins une comorbidite en rapport avec le motif de recours aux soins ou qui sont adresses par un medecin (3A) des autres patients (3B). L’echelle de tri FRENCH (FRench Emergency Nurses Classification in Hospital) a donc six niveaux de priorite. A chaque niveau de tri correspondent des motifs de recours aux soins frequents en medecine d’urgence, des modulateurs de tri, une repartition rationnelle des circuits patients et un delai maximum d’attente avant prise en charge medicale, apres evaluation par l’infirmier(iere) d’accueil. Une premiere evaluation de la FRENCH a montre qu’elle repondait aux objectifs du triage en facilitant le reperage de l’urgence complexe/severe de facon fiable et reproductible. De nouvelles evaluations sont necessaires dans d’autres structures d’urgences pour confirmer sa performance et favoriser son evolution.

/pdf/triage-des-patients-a-l-accueil-d-une-structure-d-urgences-5aoiz2ly7m.pdf

Triage des patients à l’accueil d’une structure d’urgences. Présentation de l’échelle de tri élaborée par la Société française de médecine d’urgence : la FRench Emergency Nurses Classification in Hospital (FRENCH)

Aims Pain is underestimated and insufficiently treated in Emergency Departments (ED). The primary objective of this multicenter, prospective, observational, and interventional study is to analyze the clinical impact of a simulation-based training for Emergency Nurses on pain assessment and management. Secondary objectives are to measure instructed staff's satisfaction with the simulation training and to evaluate the progress of participants as well as studying the clinical impact of this course: level of correlation between accuracy of analgesia and level of pain, assessment of patient and caregiver satisfaction. Design this study will be undertaken in EDs at two university hospitals (Paris, France: Bichat and Beaujon) with randomly selected experimental and control groups. Methods During the first phase, inventories in the EDs of current professional practice will be realized. Then, the control group will have theoretical classes and the experimental group will have both the theoretical class and simulation courses for all the nurses (with simulated patients in trauma pain scenarios). Post course assessment will be established of triage nurses' and other nurses’ practice changes concerning trauma pain management in EDs. Moreover, this study will include an assessment of the impact on patient and caregiver satisfaction. All patients over 18 years old who are admitted to the ED for a non-vital trauma are included. Exclusion criteria are patients who are admitted by an EMS ambulance. Clinical implication this study seeks to demonstrate that the implementation of a theoretical course combined with a simulation session will improve pain management in EDs by Emergency Nurses.

A multicenter randomized control trial evaluating professional practice assessment of patient pain management after simulation training course: Study protocol.

Aims
The simultaneous visits of patients to the pediatric emergency department (ED) requires the use of a triage process to determine the priority of care for incoming patients based on the severity of their illnesses. To date, there is no data on the different triage methods used in the pediatric ED in France. The main objective was to describe triage practices in the pediatric ED in France.

/pdf/enquete-nationale-sur-les-methodes-de-triage-aux-urgences-4grvlvv448.pdf

Enquête nationale sur les méthodes de triage aux urgences pédiatriques

Le triage en structure des urgences

/pdf/actualites-en-medecine-d-urgence-yrt7g7pg3a.pdf

Actualités en médecine d’urgence

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Le triage en structure des urgences

Actualités en médecine d’urgence