Implementing a sepsis prediction score in out-of-hours primary care: Feasibility and acceptability study

Abstract

BACKGROUND: Clinical scoring systems can help predict sepsis and guide treatment. We developed and validated a new sepsis prediction score for acutely ill adult patients visited at home by a general practitioner (GP) of an out-of-hours (OOH) cooperative. AIM: To assess the feasibility and acceptability of implementing this score during OOH home visits. DESIGN AND SETTING: Theory-informed mixed-methods study at two OOH GP cooperatives in the Netherlands between January and June 2024. METHOD: GPs calculated the sepsis score in adult patients during home visits and completed a questionnaire about uptake and usability. Perspectives and experiences were explored through focus groups and semi-structured interviews. RESULTS: 106 GPs visited 271 patients at home, of whom 105 were judged acutely ill by the GP. The score's uptake was 77% in all patients and 85% in those acutely ill. 91% of GPs rated the score as convenient to use, and 66% considered the score reliable and accurate. GPs reported that the score influenced their decision to refer the patient to the hospital in 6% (15/271; 11 referred, four not referred) of all cases and 10% (10/105, all referred) in acutely ill. GPs expressed that they did not solely rely on the score but found it helpful to raise sepsis awareness and as an adjunct to clinical decision-making. CONCLUSION: Implementing a new score for acutely ill adult patients visited at home during OOH primary care is feasible, and deemed acceptable and useful by GPs, however future research focusing on clinical validation and cost-effectiveness is needed.