title: Implementation of a bundle of actions to improve adherence to the Surviving Sepsis Campaign guidelines at the ED.
abstract: OBJECTIVE
  We had previously demonstrated surviving sepsis campaign guidelines had not had enough impact at our Emergency Department.
  
  
  METHODS
  Actions directed to increase the qualification of our staff and residents, to facilitate guidelines divulgation and to improve spatial conditions by creating a High Dependency Unit were implemented as a bundle. The impact of these actions on the achievement of early objectives of the campaign and on mortality was analyzed.
  
  
  RESULTS
  Following campaign guidelines was more frequent after the implementation of these actions, as shown by less restrictive fluids administration for more severe cases (P = .001), earlier administration of antibiotics (P = .001) and lactate determination rate (46% vs. 12%). In-hospital mortality difference did not reach statistical difference. Physicians were able to identify high-risk patients on clinical grounds.
  
  
  CONCLUSIONS
  The bundle of actions has had a moderate beneficial effect on our Emergency Department. High Dependency Units are useful for managing patients not fulfilling criteria for Intensive Care Unit admission.
authors.affiliation: Servicio de Urgencias, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain. jdemiguel.hgugm@salud.madrid.org
authors.forename: José M
authors.initials: JM
authors.lastname: De Miguel-Yanes
authors.forename: Javier
authors.initials: J
authors.lastname: Muñoz-González
authors.forename: Juan A
authors.initials: JA
authors.lastname: Andueza-Lillo
authors.forename: Berta
authors.initials: B
authors.lastname: Moyano-Villaseca
authors.forename: Víctor J
authors.initials: VJ
authors.lastname: González-Ramallo
authors.forename: Ana
authors.initials: A
authors.lastname: Bustamante-Fermosel
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D004635:Emergency Medicine / Q000592:standards; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006757:Hospital Units; D006801:Humans; D007362:Intensive Care Units; D017410:Practice Guidelines as Topic; D018805:Sepsis / Q000401:mortality / Q000628:therapy; D013030:Spain
chemical_list: D000900:Anti-Bacterial Agents