Development, impact and outcomes of the Hull Bacteraemia Service

BACKGROUND

Bacteraemia is a significant cause of mortality and healthcare expenditure. Evidence suggests that consultation by an infection specialist may improve outcomes.

AIM

To review the characteristics and outcomes of patients seen by a newly implemented bacteraemia service.

METHODS

Retrospective review of data collected at time of consultation. Economic analyses and benchmarking of outcomes were also performed.

RESULTS

One hundred and fifty-one patients were seen by the service over an 18-month period. Staphylococcus aureus was the most common isolate and central venous lines the most common source. Antibiotics were changed and additional investigations suggested in 62% and 61% of patients, respectively. The 30-day mortality was 19%. Implementation and delivery of the service over the 18-month study period cost pound 22,663 (pound 15,109 per year). The cost per change in antibiotic prescription was pound 244. The cost per 'near-miss' detected was pound 1193. Overall mortality was no higher and possibly lower than in published studies.

CONCLUSION

We believe that this model of care may be suitable for the management of patients with bacteraemia. A study assessing the cost-effectiveness of this approach is required.

Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery

OBJECTIVES

To determine whether preoperative optimisation of oxygen delivery improves outcome after major elective surgery, and to determine whether the inotropes, adrenaline and dopexamine, used to enhance oxygen delivery influence outcome.

DESIGN

Randomised controlled trial with double blinding between inotrope groups.

SETTING

York District Hospital, England.

SUBJECTS

138 patients undergoing major elective surgery who were at risk of developing postoperative complications either because of the surgery or the presence of coexistent medical conditions.

INTERVENTIONS

Patients were randomised into three groups. Two groups received invasive haemodynamic monitoring, fluid, and either adrenaline or dopexamine to increase oxygen delivery. Inotropic support was continued during surgery and for at least 12 hours afterwards. The third group (control) received routine perioperative care.

MAIN OUTCOME MEASURES

Hospital mortality and morbidity.

RESULTS

Overall, 3/92 (3%) preoptimised patients died compared with 8/46 controls (17%) (P=0.007). There were no differences in mortality between the treatment groups, but 14/46 (30%) patients in the dopexamine group developed complications compared with 24/46 (52%) patients in the adrenaline group (difference 22%, 95% confidence interval 2% to 41%) and 28 patients (61%) in the control group (31%, 11% to 50%). The use of dopexamine was associated with a decreased length of stay in hospital.

CONCLUSION

Routine preoperative optimisation of patients undergoing major elective surgery would be a significant and cost effective improvement in perioperative care.

The use of senior nurses in administering a standardised protocol for the pre-operative optimisation of high risk surgical patients

The pre-optimisation study is outlined. The pre-operative optimisation of high risk elective surgical patients in a District General Hospital is discussed in relation to a research study. Issues related to the development of a protocol are examined. The use of standardised protocols to guide the pre-optimisation process are focused on, emphasising the role of the senior nurse in administering the protocol.

Effects of high hydrostatic pressure on normal and neoplastic rat cells in culture

Four types of rat cells in culture were exposed to hydrostatic pressures in the range 1-1,500 bar. Each applied pressure was constant for half an hour. The morphological effects of pressure application were studied by phase contrast microscopy, and mortality was measured by total cell counts and the trypan blue exclusion test. Morphological changes characterized by cell rounding were observed in secondary fetal brain cells and fibroblasts at about 700 bar. In two permanent neoplastic neurogenic cell lines similar changes occurred at 1,000 to 1,100 bar. When approximately 50% of the cells were rounded, mortality began to increase, as compared with controls. This was gradual in secondary cells and comparatively abrupt in the permanent neoplastic lines. Malignant cells in culture may therefore be more resistant to hydrostatic pressure than their normal counterparts.