Pressure Sores and SIRS: UC Davis Quality Improvement Initiative

OBJECTIVE: Chronic pressure wounds often present through the emergency department across the country. This project aims to identify patients that met systemic inflammatory response syndrome criteria at emergency... [ view full abstract ]

• OBJECTIVE: Chronic pressure wounds often present through the emergency department across the country. This project aims to identify patients that met systemic inflammatory response syndrome criteria at emergency department presentation and were consulted for plastic surgery debridement prior to a complete medical work-up. We hypothesize that a restructuring of the ED triaging system would help conserve hospital resources and improve patient care and outcomes.
• METHODS: A retrospective chart review of 21 patients from June to December 2016 who presented through the ED with a pressure sore, met SIRS criteria, but obtained a plastic surgery consult prior to a full medical work-up. We defined SIRS based on standardized criteria.
• RESULTS: 66.67% of patients (14/21) met SIRS criteria. Of these, 50% had urosepsis or diagnosed urinary tract infection as the source of their SIRS. 
• CONCLUSION:  We propose a new algorithm for triaging pressure sore patients be established in the UC system that prioritizes a medical work-up to exclude systemic infection prior to surgical consult in order reduce cost, conserve resources, and improve patient care.