Implementation of a bundle of actions to improve adherence to the Surviving Sepsis Campaign guidelines at the ED.
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.
De Miguel-Yanes
José M
JM
Servicio de Urgencias, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain. jdemiguel.hgugm@salud.madrid.org
Muñoz-González
Javier
J
Andueza-Lillo
Juan A
JA
Moyano-Villaseca
Berta
B
González-Ramallo
Víctor J
VJ
Bustamante-Fermosel
Ana
A
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
D000900:Anti-Bacterial Agents