RESUMEN
BACKGROUND: Sepsis, an inflammatory response to an infection that may lead to severe organ dysfunction and death, is the leading cause of death in medical intensive care units. The Society of Critical Care Medicine has issued guidelines and promoted protocols to improve the management of patients with severe sepsis and septic shock. Generally, the medical community has been slow to adopt these guidelines because of the system challenges associated with protocol implementation. We describe an interdisciplinary team approach to the development and implementation of management protocols for treating patients with severe sepsis and septic shock. METHODS: To determine the effectiveness of the bundled emergency department and critical care order sets developed by the Sepsis Steering Committee, we performed a case review of 1,105 sequential patients admitted to a large academic tertiary referral hospital with a diagnosis of severe sepsis or septic shock between July 2008 and January 2012. RESULTS: Implementation of the protocol led to improved order set use over time, a significant decrease in the median time to antibiotics of 140 (range 1-820) minutes in 2008 to 72 (range 1-1,020) minutes in 2011 (P≤0.001), and a decrease in median length of stay from 8 days (range 1-54) in 2008 to 7 days (range 1-33) in 2011 (P=0.036). CONCLUSION: A multidisciplinary team approach to sepsis management using protocols and early goal-directed therapy is feasible in a large academic medical center to improve the process of care and outcomes.
RESUMEN
PURPOSE/OBJECTIVE: The objective of the study was to measure outcomes following implementation of standardized order sets for managing patients with severe sepsis/septic shock. BACKGROUND/RATIONALE: Sepsis is a severe illness, affecting approximately 750 000 people in the United States, with mortality rates of 28% to 50%, and costing $17 billion each year. PROJECT DESCRIPTION: An interdisciplinary team was created to improve early recognition and process of care in patients with severe sepsis/septic shock. Education was rolled out over 6 months, and sepsis "bundle" order sets were implemented. SETTING AND SAMPLE: Adult patients (N = 674) with a diagnosis of severe sepsis or septic shock who were admitted to an emergency department or critical care unit at a 563-bed tertiary care teaching facility from May 2008 through October 2010 were included in data analysis. METHODS: A plan, do, study, act methodology was used. Outcomes following project implementation were measured prospectively including appropriate recognition of patients with a diagnosis of sepsis, hospital site where the order set was initiated, and attainment of treatment goals within 6 hours of onset of severe sepsis/septic shock. FINDINGS: When order set usage was analyzed, the use of order sets was significantly associated with meeting "6-hour goals" successfully (χ1 [n = 662] = 36.16, P < .001); order set usage explained 24% of the variation in meeting goals, R = 0.24, F1,661 = 38.51, P < .0001. CONCLUSIONS: Order sets improved management of septic patients through effective change in delivery systems to support evidence-based medical care. IMPLICATIONS FOR PRACTICE: Administrative support, team collaboration, and standardized order sets can lead to improved process of care.