Data set of Sepsis awareness at the university hospital level: a survey-based cross-sectional study

This is the dataset for the SAfE survey We conducted a survey on nurses and physicians distributed over all adult departments of the Lausanne University Hospital (LUH) and local paramedics. The survey aimed to assess professionals’ demographics (age, profession, seniority, unit of activity), prior sepsis education, perceptions, knowledge of sepsis epidemiology, definition, recognition and management. Correlation between surveyed personel and sepsis perceptions and knowledge were assessed with univariate logistic regression models. Methods: The research team designed a survey inspired from previously published surveys assessing knowledge and awareness of sepsis. The questions were tailored to the profession (clinical scenario adapted activity sector - medicine, surgery, emergency department or gynecology). The survey was written and completed in French. Each section of the survey (paramedics’, nurses’ and physicians’ section) was submitted to three focus groups consisting of 3 to 6 participants of each profession, commonly involved in care of patients with sepsis. These focus groups assessed the applicability and appropriateness (validity) of the survey. The focus group were constituted of nurses, physicians and paramedics of all seniority levels. Their primary task was in assessing whether formulations and relevance of questions were adequate. The survey was revised using feedback from the groups. Surveys of nursing staff and paramedics were more focused on screening, initial evaluation and early management whereas physicians were also tested on diagnosis and management. Responses options included Likert-type scales, binary (e.g. “yes/no”) or multiple choices. Each question was locked upon answering, which prevented post hoc changes that could be influenced by information provided at a later stage of the survey. The final survey contained questions on participants’ demographic characteristics (5/7/6 questions for nurses/paramedics/physicians), sepsis continuous education (3/3/3 questions), self-evaluation of sepsis knowledge and clinical management (2/2/2 questions), definitions, scores and epidemiology (11/12/14 questions), and sepsis management (4/4/5 questions). The survey was developed in REDCap (Research Electronic Data Capture) software so as to automatically export participants’ responses to a database. Surveys are provided as supplementary material (supp. meth. survey). Participants were recruited between January 20 and October 10, 2020. We aimed for a convenience sample size of 1,000 persons (approx. 20% of the active HCPs) distributed over all departments (Emergency department (ED), intensive care unit (ICU), Medicine, Paramedic, Psychiatry, or Surgery) and professions (paramedics, nurses and physicians) to reach 20% of LUH staff considered HCPs, being as representative as possible. Pediatrics and neonatology staff (not covered by Sepsis-3 consensus definitions) as well as nurses and physicians not in daily contact with patients (i.e., who were working in research team or in administration) were excluded. We favored a supervised approach rather than a dissemination of the survey to all HCPs by email. Participants answered the online survey under trained interviewer supervision so as maximize data quality and to avoid biased responses (internet queries, discussions between colleagues). Furthermore, to avoid multiple answers by a same HCP, surveys were accessed by QR-code only available at screening; timing of survey completion was registered and email addresses were registered. Thus, participants were screened amongst the medical (n=1664) and nursing staff (n=2463) in daily contact with patients of LUH and amongst paramedics of the Canton of Vaud (n=290) during the screening period. Screening by trained interviewers took place during scheduled patient hand-offs, seminars or group meetings, as permitted by heads of units. Participation was voluntary and anonymous. Participants completed the online survey using tablets or smartphones (participants’ or provided by the investigators). Results: Between January and October 2020, 1,116 of 1,216 contacted professionals completed the survey (participation rate 91.8%). These participants represented about 25% of the workforce (n=4417) – i.e., 25.1% of nurses (619/2,463), 20.9 % of physicians (348/1,664),and 51.4% of paramedics (149/290). Only 13% of participants (physicians: 28.4%, nurses: 5.9%, paramedics: 6.8%) correctly identified the Sepsis-3 consensus definition. Similarly, less than 50% of participants (physicians: 48.6%, nurses: 10.0%) selected the SOFA score as a sepsis defining score for infected patients. Furthermore, 24% of participants properly identified the qSOFA score as a predictor of increased mortality; and 6% selected correctly its components. For a suspected sepsis, 96.1%, 91.6% and 75.8% of physicians respectively chose blood cultures, broad-spectrum antibiotics and fluid resuscitation as required interventions; 76.4% and 18.2% of physicians requested initial measures within 1 and 3 hours, respectively. For physicians, recent training correlated with awareness regarding definitions, SOFA and qSOFA score use and components: ORs (95%CI) 2.2 (1.4-3.6), 4.3 (2.7-6.7), 3.4 (2.2-5.2), and 2.6 (1.5-4.6), respectively). Conclusions: We identify a deficit of awareness among physicians, nurses and paramedics at LUH correlating with a lack of sepsis-specific training.本数据集对应SAfE调研项目。本研究针对洛桑大学医院（Lausanne University Hospital, LUH）所有成人科室的医护人员及当地急救医护人员开展调研，旨在评估受访人员的人口统计学特征（年龄、职业、从业年限、所在科室）、既往脓毒症培训经历、认知态度、脓毒症流行病学知识、定义、识别与处置方案，并采用单变量logistic回归模型分析受访人员特征与脓毒症认知、知识水平之间的相关性。 ### 方法 研究团队参考既往发表的脓毒症知识与认知调研工具，设计本调研问卷。问卷题目根据职业进行定制（临床场景适配不同科室：内科、外科、急诊科或妇产科），以法语编写与作答。针对急救医护、护士与医师三个群体的问卷模块，分别由各职业组内3~6名常参与脓毒症患者救治的人员组成的3个焦点小组评审，以评估问卷的适用性与恰当性（效度）。参与焦点小组的人员覆盖各从业年限层级的护士、医师与急救医护，核心任务为评估问卷题目的表述与相关性是否合理。研究团队根据焦点小组反馈对问卷进行修订。 护理人员与急救医护的问卷模块更侧重于筛查、初始评估与早期处置，而医师模块额外考察脓毒症的诊断与处置能力。问卷作答选项包括李克特量表、二分类（如“是/否”）及多选题。每道题目提交作答后即锁定，避免受访者受问卷后续题目信息影响而修改此前答案。 最终版问卷包含以下模块题目：参与者人口统计学特征（护士/急救医护/医师分别对应5/7/6道题目）、脓毒症继续教育（各职业组均为3道题目）、脓毒症知识与临床处置能力自评（各职业组均为2道题目）、脓毒症定义、评分与流行病学知识（护士/急救医护/医师分别对应11/12/14道题目），以及脓毒症处置方案（护士/急救医护/医师分别对应4/4/5道题目）。本调研基于REDCap（Research Electronic Data Capture，电子研究数据捕获）软件开发，可自动将受访者作答结果导出至数据库。调研问卷作为补充材料提供（补充方法：调研问卷）。 本次调研招募时间为2020年1月20日至10月10日。研究计划纳入1000名符合条件的受试者（约占在职医疗保健人员（Healthcare Personnel, HCP）的20%），覆盖所有科室（急诊科（Emergency Department, ED）、重症监护室（Intensive Care Unit, ICU）、内科、急救科、精神科及外科）与职业（急救医护、护士与医师），以尽可能贴合洛桑大学医院在职HCP的群体特征。本研究排除儿科与新生儿科医护人员（因Sepsis-3共识定义未覆盖该群体），以及未日常接触患者的护士与医师（如从事研究或行政工作的人员）。 相较于通过电子邮件向全体HCP群发问卷的方式，本研究采用现场督导的招募方式。受访者在经过培训的调研人员监督下完成线上问卷，以最大化数据质量并避免作答偏倚（如网络搜索、同事间讨论影响作答）。此外，为避免同一HCP多次作答，问卷仅通过筛查阶段提供的二维码访问；调研完成时长与受访者电子邮箱均被记录。 调研阶段，研究人员从日常接触患者的洛桑大学医院内科医护人员（n=1664）、护理人员（n=2463），以及沃州的急救医护人员（n=290）中筛选受试者。经培训的调研人员在科室主任许可的情况下，于患者交接班时段、研讨会或团队会议期间开展筛查。本次调研自愿参与且匿名，受访者可使用个人或研究人员提供的平板电脑或智能手机完成线上问卷。 ### 结果 2020年1月至10月期间，1216名受访医护人员中有1116名完成问卷，应答率为91.8%。本次纳入的受试者约占洛桑大学医院在职医护人员总数（n=4417）的25%，其中护士占比25.1%（619/2463）、医师占比20.9%（348/1664）、急救医护占比51.4%（149/290）。仅13%的受试者能够正确识别Sepsis-3共识定义（医师：28.4%，护士：5.9%，急救医护：6.8%）。类似地，仅有不到50%的受试者（医师：48.6%，护士：10.0%）能够正确选择SOFA评分作为感染患者的脓毒症判定评分。此外，24%的受试者能够正确识别qSOFA评分可预测死亡率升高，仅6%的受试者能够准确说出qSOFA评分的组成条目。 对于疑似脓毒症病例，分别有96.1%、91.6%与75.8%的医师选择血培养、广谱抗生素与液体复苏作为必要干预措施；76.4%与18.2%的医师能够在1小时与3小时内完成初始处置。针对医师群体的分析显示，近期接受过脓毒症培训与对脓毒症定义、SOFA及qSOFA评分的使用与组成的认知水平显著相关，对应比值比（95%置信区间）分别为2.2（1.4~3.6）、4.3（2.7~6.7）、3.4（2.2~5.2）与2.6（1.5~4.6）。 ### 结论 本研究发现洛桑大学医院的医师、护士与急救医护人员对脓毒症的认知存在不足，且该不足与缺乏针对性脓毒症培训密切相关。