title: Introduction of a comprehensive management protocol for severe sepsis is associated with sustained improvements in timeliness of care and survival.
abstract: BACKGROUND
  Mortality from severe sepsis can be improved by timely diagnosis and treatment. This study investigates the effectiveness of a comprehensive management protocol for recognition and initial treatment of severe sepsis that spans from the emergency department (ED) to the intensive care unit.
  
  
  METHODS
  Interventions included development of a management algorithm including early goal-directed therapy, a computerised physician order entry set for suspected sepsis, introduction of invasive haemodynamic monitoring and antibiotics stocked in the ED, and an extensive education campaign involving ED nurses and physicians.
  
  
  RESULTS
  In the 6 months after introduction of the protocol, 37 patients who had severe sepsis were identified in the ED. Compared to a randomly selected group of 37 patients who had severe sepsis and who were transferred directly to the intensive care unit before introduction of the protocol, significant improvements were observed in mean time to initiation of early goal-directed therapy (3.2 vs 10.4h, p=0.001) and to achievement of resuscitation goals (10.4 vs 30.1h, p=0.007). There was a trend towards more rapid administration of antibiotics (1.4 vs 2.7h, p=0.06). This was associated with a decrease in crude hospital mortality rate from 51.4% to 27.0% (absolute risk reduction=24%, 95% CI 3% to 47%). Improvements were sustained in the follow-up audit at 16 months.
  
  
  CONCLUSIONS
  Introduction of a comprehensive management protocol to address early recognition and management of severe sepsis in the ED is associated with sustained improvements in processes of care.
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. rmacredmond@mrl.ubc.ca
authors.forename: R
authors.initials: R
authors.lastname: MacRedmond
authors.forename: K
authors.initials: K
authors.lastname: Hollohan
authors.forename: R
authors.initials: R
authors.lastname: Stenstrom
authors.forename: R
authors.initials: R
authors.lastname: Nebre
authors.forename: D
authors.initials: D
authors.lastname: Jaswal
authors.forename: P
authors.initials: P
authors.lastname: Dodek
mesh_terms: D000328:Adult; D000368:Aged; D001955:British Columbia; D002985:Clinical Protocols; D004636:Emergency Service, Hospital; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000458:organization & administration*; D011785:Quality Assurance, Health Care; D018805:Sepsis / Q000503:physiopathology*; D012720:Severity of Illness Index