Background: The effectiveness of electronic medical record-based alert systems, response protocols for sepsis diagnosis, and treatment in hospitalized patients remains unclear. This study aimed to determine whether the introduction of an electronic medical record-based sepsis response protocol (SRP) along with a 24/7 operating rapid response system affects the prognosis for patients with hospital-onset sepsis. Methods: In August 2022, a SRP based on the National Early Warning Score was implemented in the electronic medical record system at Asan Medical Center. We retrospectively analyzed patients screened by the detection system for 1 year after the SRP implementation. Patients of the first 6 months (preliminary group) and those of the second 6 months (SRP group) were matched 1:1 based on propensity scores. The primary outcome was 30-day mortality. Results: Of the 608 hospitalized patients screened by the system, 176 were assigned to each group after 1:1 propensity score matching. Patients in the SRP group were significantly more likely to receive blood cultures (58.5%) compared with the preliminary group (45.5%) (P=0.019). The SRP group showed a lower 30-day mortality risk (hazard ratio, 0.56; 95% CI, 0.36–0.86; P=0.017) compared to the preliminary group. A restricted cubic spline curve showed that SRP survival benefit began to manifest after the first 4 months (P=0.036). Conclusions Alongside an existing rapid response system, the National Early Warning Score-based SRP in the electronic medical record reduced mortality for hospital-onset sepsis within 1 year.

Purpose: In the emergency department (ED), triage significantly impacts patient safety. Therefore, triage nurses must make decisions accurately and timeously. This study aims to investigate how South Korean pediatric emergency nurses perceive urgency and classify severity using the Q methodology, which examines individuals' subjectivity. Methods: We collected 84 statements from a Q population based on a literature review and interviews and selected 33 Q samples. The P samples included 30 pediatric emergency nurses at a Seoul tertiary care hospital. The principal component factor analysis method was used to analyze data using the PC-QUANL program. Results: Four urgency perception types were identified among pediatric ED nursesdType 1: “Experiential coping”; Type 2: “Careful reasoning”; Type 3: “Patient-centered thinking”; and Type 4: “Intuitive prediction.” These types appear to be an integrated process of knowledge and clinical experience that considers children's characteristics and developmental stages. Conclusion This study may serve as a basis for future education to improve pediatric ED nurses 0 urgency judgment and severity classification skills.

Purpose: In the emergency department (ED), triage significantly impacts patient safety. Therefore, triage nurses must make decisions accurately and timeously. This study aims to investigate how South Korean pediatric emergency nurses perceive urgency and classify severity using the Q methodology, which examines individuals' subjectivity. Methods: We collected 84 statements from a Q population based on a literature review and interviews and selected 33 Q samples. The P samples included 30 pediatric emergency nurses at a Seoul tertiary care hospital. The principal component factor analysis method was used to analyze data using the PC-QUANL program. Results: Four urgency perception types were identified among pediatric ED nursesdType 1: “Experiential coping”; Type 2: “Careful reasoning”; Type 3: “Patient-centered thinking”; and Type 4: “Intuitive prediction.” These types appear to be an integrated process of knowledge and clinical experience that considers children's characteristics and developmental stages. Conclusion This study may serve as a basis for future education to improve pediatric ED nurses 0 urgency judgment and severity classification skills.

Purpose: In the emergency department (ED), triage significantly impacts patient safety. Therefore, triage nurses must make decisions accurately and timeously. This study aims to investigate how South Korean pediatric emergency nurses perceive urgency and classify severity using the Q methodology, which examines individuals' subjectivity. Methods: We collected 84 statements from a Q population based on a literature review and interviews and selected 33 Q samples. The P samples included 30 pediatric emergency nurses at a Seoul tertiary care hospital. The principal component factor analysis method was used to analyze data using the PC-QUANL program. Results: Four urgency perception types were identified among pediatric ED nursesdType 1: “Experiential coping”; Type 2: “Careful reasoning”; Type 3: “Patient-centered thinking”; and Type 4: “Intuitive prediction.” These types appear to be an integrated process of knowledge and clinical experience that considers children's characteristics and developmental stages. Conclusion This study may serve as a basis for future education to improve pediatric ED nurses 0 urgency judgment and severity classification skills.

Background/Aims: The quick Sepsis-related Organ Failure Assessment (qSOFA) is a newly developed risk stratification tool, which has been presented along with a new sepsis definition, to classify infected patients outside of the intensive care unit (ICU). We evaluated the clinical usefulness of qSOFA for predicting adverse outcomes in sepsis patients with liver cirrhosis. Methods: We performed a retrospective cohort study to assess the utility of qSOFA in sepsis patients with liver cirrhosis for whom medical emergency teams (METs) were activated in general wards at an academic tertiary care hospital between March 2008 and December 2015. qSOFA, Systemic inflammatory response syndrome (SIRS), modified early warning score (MEWS), and sequential (sepsis- related) organ failure assessment (SOFA) scores were calculated according to data at MET activation. Results: Of 188 patients, 69 (36.7%) had a qSOFA score of 0 or 1 point and 119 (63.3%) had ≥ 2 points. The areas under the receiver operating characteristic curve (AUROC) for ICU transfer on the SOFA (AUROC, 0.691; 95% confidence interval [CI], 0.615 to 0.767) or MEWS (AUROC, 0.663; 95% CI, 0.586 to 0.739) were significantly higher compared to those for qSOFA (AUROC, 0.589; 95% CI, 0.507 to 0.671) or SIRS (AUROC, 0.533; 95% CI, 0.451 to 0.616). Conclusions Our findings suggest that qSOFA score may have limited utility in predicting adverse outcomes in sepsis patients with liver cirrhosis at MET activation. Either MEWS or another screening tool is needed for detecting early sepsis in these patients.