title: The utility of a quality improvement bundle in bridging the gap between research and standard care in the management of severe sepsis and septic shock in the emergency department.
abstract: The research in the management of severe sepsis and septic shock has resulted in a number of therapeutic strategies with significant survival benefits. These results also emphasize the primary importance of early hemodynamic resuscitation, or early goal-directed therapy (EGDT), and place the emergency physician in the center of the multidisciplinary team caring for patients with this disease. However, in a busy emergency department, the translation of research into clinical practice is far from ideal. While the benefits are significant, the successful implementation of EGDT is filled with challenges and obstacles. In this article, we will discuss the steps taken at our institution to create, implement, measure, and improve on a six-hour severe sepsis and septic shock treatment bundle incorporating EGDT in the emergency department setting, resulting in significant mortality benefit.
authors.affiliation: Department of Emergency Medicine, Loma Linda University, Loma Linda, CA, USA. hbnguyen@llu.edu
authors.forename: H Bryant
authors.initials: HB
authors.lastname: Nguyen
authors.forename: Elizabeth Lea
authors.initials: EL
authors.lastname: Lynch
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Mou
authors.forename: Kristopher
authors.initials: K
authors.lastname: Lyon
authors.forename: William A
authors.initials: WA
authors.lastname: Wittlake
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Corbett
mesh_terms: D004059:Diffusion of Innovation; D004636:Emergency Service, Hospital / Q000592:standards*; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D019359:Knowledge; D016017:Odds Ratio; D010348:Patient Care Team; D011787:Quality of Health Care; D018805:Sepsis / Q000628:therapy*; D012772:Shock, Septic / Q000628:therapy*