Standardization of severe sepsis management: a survey of methodologies in academic and community settings.
BACKGROUND
Evidence-based therapies for severe sepsis include early antibiotics, early goal-directed therapy, corticosteroids, recombinant human activated protein C, glucose control, and lung protective strategies.


OBJECTIVE
The objective of this study was to analyze methods, challenges, and outcomes observed by hospitals that implemented a hospital-wide sepsis management protocol incorporating evidence-based therapies.


METHODS
In a cross-sectional multi-center telephone survey over a 4-month period, clinicians (participants) responsible for developing a hospital sepsis protocol were questioned regarding its development and outcomes.


RESULTS
Participants completing surveys represented 40 hospitals (20 academic and 20 community). Twenty-seven percent of protocol champions were Emergency physicians or nurses. Sixty-three percent reported protocol development time of 6-12 months. Eighty-eight percent of participants reported protocol initiation in the Emergency Department. Three participants reported hiring a nurse educator to implement the protocol. Ninety-five percent of participants measure lactate as part of patient screening. Protocol therapies reported included early antibiotics (98%), early goal directed-therapy (EGDT) (98%), corticosteroids (80%), and activated protein C (73%). Contributions to success included having a protocol champion (85%) and sepsis education program (65%). Twenty-one participants had recorded patient-level data, totaling 2319 protocol patients, compared to 1719 non-protocol patients, with in-hospital mortality of 23% and 44%, respectively.


CONCLUSIONS
Implementation of a sepsis management protocol incorporating evidence-based therapies can be accomplished in both academic and community hospitals, with minimal additional staffing. The presence of a protocol champion and education program is crucial to success, and may result in improved patient outcome.
Nguyen
H Bryant
HB
Department of Emergency Medicine, Loma Linda University, Loma Linda, California 92354, USA.
Oh
Jason
J
Otero
Ronny M
RM
Burroughs
Kristy
K
Wittlake
William A
WA
Corbett
Stephen W
SW
D000046:Academic Medical Centers / Q000458:organization & administration*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002985:Clinical Protocols; D003153:Community Health Services / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D006801:Humans; D018805:Sepsis / Q000188:drug therapy*; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents