Implementation of a bundle of actions to improve adherence to the Surviving Sepsis Campaign guidelines at the ED.

ABSTRACT

PURPOSES: We had previously demonstrated surviving sepsis campaign guidelines had not had enough impact at our Emergency Department. BASIC PROCEDURES Actions directed to increase the qualification of our staff and residents, to facilitate guidelines divulgation and to improve spatial conditions by creating a High Dependency Unit were implemented as a bundle. The impact of these actions on the achievement of early objectives of the campaign and on mortality was analyzed. MAIN FINDINGS: Following campaign guidelines was more frequent after the implementation of these actions, as shown by less restrictive fluids administration for more severe cases (P = .001), earlier administration of antibiotics (P = .001) and lactate determination rate (46% vs. 12%). In-hospital mortality difference did not reach statistical difference. Physicians were able to identify high-risk patients on clinical grounds. PRINCIPAL CONCLUSIONS: The bundle of actions has had a moderate beneficial effect on our Emergency Department. High Dependency Units are useful for managing patients not fulfilling criteria for Intensive Care Unit admission.