Assessing the effect of the Surviving Sepsis Campaign treatment guidelines on clinical outcomes in a community hospital.
BACKGROUND
Bundles yield a reduction in mortality in patients with sepsis, but the majority of the data is from large academic centers. The ability of a community hospital to implement a sepsis bundle successfully, however, has not been investigated.


OBJECTIVE
To examine the effect of a collaborative 2-part sepsis bundle on clinical outcomes and mortality at a community hospital.


METHODS
The study included all patients with severe sepsis/septic shock over the age of 18 years admitted to the intensive care unit (ICU) from 2006 to 2007 who were not treated with a bundle (n = 53) and those who were treated with a bundle (n = 59). Data collected included demographics; initiation of vasopressors; days on vasopressors; blood glucose; use of drotrecogin alfa (activated), steroids, and ventilator; ICU/hospital lengths of stay; ventilator days; time to culture; time to first dose of antibiotics; time to transfer from emergency department to ICU; fluid resuscitation in the first 24 hours; percentage of patients started on dialysis; and mortality.


RESULTS
Demographics; blood glucose; use of drotrecogin alfa (activated), steroids and ventilator; ICU/hospital lengths of stay; and ventilator days were statistically similar between groups. Median time to cultures, first dose of antibiotics, and transfer to ICU were all reduced with the bundle. Percentage of non-bundle patients on vasopressors was 87% versus 66.7% of bundle patients (p = 0.011) and number of median days on vasopressors was reduced. Fewer bundle patients were initiated on dialysis (0%) versus non-bundle patients (14.8%) (p = 0.02). Median fluid administered in the first 24 hours was 2200 mL (10-13,996 mL) for non-bundle patients and 7143 mL (1000-19,104 mL) for bundle patients (p < 0.001). Mortality was 61.1% in the non-bundle group versus 20% with the bundle (p < 0.001).


CONCLUSIONS
Implementation of a 2-part sepsis bundle based on the Surviving Sepsis Campaign Guidelines can yield a positive impact on clinical outcome and mortality in a nonacademic, community hospital setting.
Pharmacy Department, The Medical Center of Plano, TX, USA. Gita.patel@hcahealthcare.com
Gita Wasan
GW
Patel
Nicki
N
Roderman
Hollie
H
Gehring
John
J
Saad
William
W
Bartek
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis; D002985:Clinical Protocols; D003299:Cooperative Behavior; D005260:Female; D017052:Hospital Mortality; D006764:Hospitals, Community / Q000379:methods* / Q000458:organization & administration; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011486:Protein C / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D001786:Blood Glucose; D011486:Protein C; D011994:Recombinant Proteins; C421124:drotrecogin alfa activated