[Construction and application of early warning and grading intervention strategy for critically ill inpatients based...

To construct and apply an early warning and graded intervention strategy for hospitalized critically ill patients based on the dynamic Sequential Organ Failure Assessment (SOFA), and to evaluate its implementation effect.

An early warning information system based on the SOFA score was developed for all hospital wards, and a graded intervention strategy was formulated according to changes in SOFA score (ΔSOFA). Twenty-eight general wards of Tianjin Third Central Hospital were selected as implementation sites for the graded intervention strategy. Patients under special or first level care before (July 1 to December 31, 2023) and after (January 1 to June 30, 2024) strategy implementation were compared regarding sex, age, care level at initial SOFA assessment, admission diagnosis category, length of hospital stay, and proportion transferred to the intensive care unit (ICU). Among patients admitted to the ICU before and after implementation, the following indicators were recorded and compared: sex, age, diagnosis upon ICU admission, proportion of unplanned ICU admission, proportion with an Acute Physiology and Chronic Health Evaluation II(APACHE II)≥25 within 24 hours of ICU admission, proportion receiving mechanical ventilation, prone position ventilation and extracorporeal circulatory support, duration of mechanical ventilation, length of ICU stay, and 7 day ICU mortality. Quality control was conducted throughout the implementation process, and the accuracy and timeliness rates of SOFA score assessments were calculated.

A total of 16 982 patients receiving special or first level care were enrolled, including 8 611 before strategy implementation and 8 371 after implementation. No significant differences were observed between the two groups in gender, age, care level at initial SOFA assessment, or admission diagnosis category. The length of hospital stay [days: 7.0 (5.0, 10.0) vs. 7.0 (5.0, 10.0)] and rate of ICU transfer [1.89% (163/8 611) vs. 2.17% (182/8 371)] were also similar (both P>0.05). A total of 163 and 182 patients were transferred to the ICU before and after implementation, respectively. No significant differences were found in sex, age, diagnosis on ICU admission, proportion receiving mechanical ventilation, proportion receiving prone-position ventilation, proportion of patients receiving extracorporeal circulatory support, or length of ICU stay between the two ICU subgroups. However, after strategy implementation, the unplanned ICU transfer rate [36.8% (67/182) vs. 47.9% (78/163)], the proportion of patients with APACHE II score≥25 within 24 hours of ICU admission [30.8% (56/182) vs. 42.9% (70/163)], and 7-day ICU mortality [14.8% (27/182) vs. 23.3% (38/163)] were significantly lower than those before implementation, and the duration of mechanical ventilation [days: 2.0 (0.0, 4.5) vs. 2.0 (1.0, 6.0)] was significantly shorter (all P<0.05). During the implementation period, a total of 27 754 SOFA score assessments were performed; an early warning was triggered in 1 112 instances (ΔSOFA score≥1). Among patients transferred to the ICU after SOFA-based early warning, the proportion reached 25.8% (47/182). Special inspections were conducted 502 times. The timeliness and accuracy rates of ΔSOFA score assessment showed increasing trends, reaching 92.0% (80/87) and 93.1% (81/87), respectively, at the end of the intervention period.

The dynamic SOFA-based early warning and graded intervention strategy for hospitalized critically ill patients provides a feasible approach for medical staff in general wards to identify potential critically ill patients at an early stage. By involving the critical care specialist team in graded interventions, this strategy effectively ensures patient safety and improves clinical outcomes.