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Effect of an emergency department sepsis protocol on the care of septic patients admitted to the intensive care unit

Published online by Cambridge University Press:  21 May 2015

David D. Sweet*
Affiliation:
Departments of Emergency Medicine and Critical Care Medicine, Vancouver General Hospital, Vancouver, BC
Dharmvir Jaswal
Affiliation:
Departments of Emergency Medicine and Critical Care Medicine, Vancouver General Hospital, Vancouver, BC
Winnie Fu
Affiliation:
Departments of Emergency Medicine and Critical Care Medicine, Vancouver General Hospital, Vancouver, BC
Matt Bouchard
Affiliation:
Departments of Emergency Medicine and Critical Care Medicine, Vancouver General Hospital, Vancouver, BC
Praveena Sivapalan
Affiliation:
Departments of Emergency Medicine and Critical Care Medicine, Vancouver General Hospital, Vancouver, BC
Jen Rachel
Affiliation:
Departments of Emergency Medicine and Critical Care Medicine, Vancouver General Hospital, Vancouver, BC
Dean Chittock
Affiliation:
Departments of Emergency Medicine and Critical Care Medicine, Vancouver General Hospital, Vancouver, BC
*
Department of Critical Care Medicine, Vancouver General Hospital, 855 West 12th Ave., Vancouver BC V5Z 1M9; [email protected]

Abstract

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Objective:

We sought to determine whether the implementation of a sepsis protocol in a Canadian emergency department (ED) improves care for the subset of patients admitted to the intensive care unit (ICU).

Methods:

After implementing a sepsis protocol in our ED we used an ICU database and chart review to compare various time-dependent end points and outcomes between a historical control year and the first year after implementation. We reviewed the charts of all patients admitted to the ICU within 24 hours of ED admission with a primary or other diagnosis of sepsis, severe sepsis or septic shock, who met criteria for early goal-directed therapy within the first 6 hours of their ED stay.

Results:

We compared 29 patients from the control year with 30 patients from the year after implementation of our sepsis protocol. We found that patients treated during the postintervention year had improvements in time to antibiotics (4.2 v. 1.0 h, difference = –3.2 h, 95% CI –4.8 to –2.0), time to central line placement (above the diaphragm) (11.6 v. 3.2 h, difference = –8.4 h, 95% CI –12.1 to –4.7), time to arterial line placement (7.5 v. 2.3 h, difference = –5.2 h, 95% CI –7.4 to –3.0), and achievement of central venous pressure and central venous oxygen saturation goals (11.1 v. 5.1 h, difference = –6.0 h, 95% CI –11.03 to –1.71, and 13.1 v. 5.5 h, difference = –7.6 h, 95% CI –11.97 to –3.16, respectively). There were no statistically significant differences in ICU length of stay, hospital length of stay or mortality (31.0% v. 20.0%, difference = –11.0%, 95% CI –33.1% to 11.1%).

Conclusion:

Implementation of an ED sepsis protocol improves care for patients with severe sepsis and septic shock.

Type
Original Research • Recherche originale
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

References

REFERENCES

1.Nguyen, HB, Rivers, EP, Abrahamian, FM, et al. Severe sepsis and septic shock: review of the literature and emergency department management guidelines. Ann Emerg Med 2006;48:2854.CrossRefGoogle ScholarPubMed
2.Rivers, E, Nguyen, B, Havstad, S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368–77.Google Scholar
3.Trzeciak, S, Dellinger, RP, Abate, NL, et al. Translating research to clinical practice: a 1-year experience with implementing early goal-directed therapy for septic shock in the emergency department. Chest 2006;129:225–32.Google Scholar
4.Jones, AE, Foche, A, Horton, JM, et al. Prospective external validation of the clinical effectiveness of an emergency department-based early goal-directed therapy protocol for severe sepsis and septic shock. Chest 2007;132:425–32.Google Scholar
5.Shapiro, NI, Howell, MD, Talmor, D, et al. Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol. Crit Care Med 2006;34:1025–32.Google Scholar
6.Gao, F, Melody, T, Daniels, DF, et al. The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational study. Crit Care 2005;9:R764–70.Google Scholar
7.Kortgen, A, Niederprum, P, Bauer, M. Implementation of an evidence-based “standard operating procedure” and outcome in septic shock. Crit Care Med 2006;34:943–9.Google Scholar
8.Micek, ST, Roubinian, N, Heuring, T, et al. Before-after study of a standardized hospital order set for the management of septic shock. Crit Care Med 2006;34:2707–13.CrossRefGoogle ScholarPubMed
9.Sebat, F, Johnson, D, Musthafa, AA, et al. A multidisciplinary community hospital program for early and rapid resuscitation of shock in nontrauma patients. Chest 2005;127:1729–43.Google Scholar
10.Nguyen, HB, Corbett, SW, Steele, R, et al. Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med 2007;35:1105–12.Google Scholar
11.Rogove, J, Pyle, K. Collaboration for instituting the surviving sepsis campaign in a community hospital. Crit Care Med 2005;33(12 Suppl):A28.Google Scholar
12.Verceles, A, Schwarcz, RM, Garcha, P, et al. Factors influencing survival in patients with severe sepsis treated with a therapeutic pathway. Chest 2006;130:223S.CrossRefGoogle Scholar
13.Stenstrom, RJ, Hollohan, K, Nebre, R. Impact of a sepsis protocol for the management of patients with severe sepsis and septic shock in the emergency department. CJEM 2006;8:S16.Google Scholar
14.Otero, RM, Nguyen, HB, Huang, DT, et al. Early goal-directed therapy in severe sepsis and septic shock revisited: concepts, controversies, and contemporary findings. Chest 2006;130:1579–95.CrossRefGoogle ScholarPubMed
15.Beveridge, R, Clarke, B, Janes, L, et al. Canadian Emergency Department Triage and Acuity Scale: implementation guidelines. CJEM 1999;1(Suppl3).Google Scholar
16.Kumar, A, Roberts, D, Wood, KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34:1589–96.Google Scholar
17.Angus, D, Kellum, J, Yealy, D. Protocolized care for early septic shock (ProCESS). Bethesda (MD): National Library of Medicine; 2009. Available: http://clinicaltrials.gov/ct2/show/NCT00510835. ClinicalTrials.gov identifier: NCT00510835.Google Scholar