title: Before-after study of a standardized hospital order set for the management of septic shock.
abstract: OBJECTIVE
  To evaluate a standardized hospital order set for the management of septic shock in the emergency department.
  
  
  METHODS
  Before-after study design with prospective consecutive data collection.
  
  
  METHODS
  Emergency department of a 1,200-bed academic medical center.
  
  
  METHODS
  A total of 120 patients with septic shock.
  
  
  METHODS
  Implementation of a standardized hospital order set for the management of septic shock.
  
  
  RESULTS
  A total of 120 consecutive patients with septic shock were identified. Sixty patients (50.0%) were managed before the implementation of the standardized order set, constituting the before group, and 60 (50.0%) were evaluated after the implementation of the standardized order set, making up the after group. Demographic variables and severity of illness measured by the Acute Physiology and Chronic Health Evaluation II were similar for both groups. Patients in the after group received statistically more intravenous fluids while in the emergency department (2825 +/- 1624 mL vs. 3789 +/- 1730 mL, p = .002), were more likely to receive intravenous fluids of >20 mL/kg body weight before vasopressor administration (58.3% vs. 88.3%, p < .001), and were more likely to be treated with an appropriate initial antimicrobial regimen (71.7% vs. 86.7%, p = .043) compared with patients in the before group. Patients in the after group were less likely to require vasopressor administration at the time of transfer to the intensive care unit (100.0% vs. 71.7%, p < .001), had a shorter hospital length of stay (12.1 +/- 9.2 days vs. 8.9 +/- 7.2 days, p = .038), and a lower risk for 28-day mortality (48.3% vs. 30.0%, p = .040).
  
  
  CONCLUSIONS
  Our study found that the implementation of a standardized order set for the management of septic shock in the emergency department was associated with statistically more rigorous fluid resuscitation of patients, greater administration of appropriate initial antibiotic treatment, and a lower 28-day mortality. These data suggest that the use of standardized order sets for the management of septic shock should be routinely employed.
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, St Louis, MO, USA.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Micek
authors.forename: Nareg
authors.initials: N
authors.lastname: Roubinian
authors.forename: Tim
authors.initials: T
authors.lastname: Heuring
authors.forename: Meghan
authors.initials: M
authors.lastname: Bode
authors.forename: Jennifer
authors.initials: J
authors.lastname: Williams
authors.forename: Courtney
authors.initials: C
authors.lastname: Harrison
authors.forename: Theresa
authors.initials: T
authors.lastname: Murphy
authors.forename: Donna
authors.initials: D
authors.lastname: Prentice
authors.forename: Brent E
authors.initials: BE
authors.lastname: Ruoff
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002985:Clinical Protocols / Q000592:standards*; D004636:Emergency Service, Hospital; D005260:Female; D005440:Fluid Therapy; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D015999:Multivariate Analysis; D010346:Patient Care Management / Q000592:standards*; D011446:Prospective Studies; D012015:Reference Standards; D012307:Risk Factors; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy*; D018746:Systemic Inflammatory Response Syndrome / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014662:Vasoconstrictor Agents