title: Evaluation of process variations in noncompliance in the implementation of evidence-based sepsis care.
abstract: BACKGROUND
  Sepsis is recognized as an often-lethal disease. Recommended guidelines are complex and time sensitive. Response teams (RTs) have demonstrated success in implementation of quality initiatives. The purpose of this study was to evaluate variations in noncompliance with recommended sepsis guidelines overall and between a sepsis-focused RT and standard care.
  
  
  METHODS
  This retrospective chart review categorized septic patients based on treatment by a sepsis response team (SRT) versus standard care (non-SRT). Guideline compliance was based upon the Surviving Sepsis evaluation and treatment guidelines.
  
  
  RESULTS
  Patient records for 123 identified septic patients post first-year implementation were evaluated. Overall, compliance rates were low and there were variations in compliance between the treatment providers. The SRT was more compliant than the non-SRT. SRT noncompliance was more often due to failure to achieve therapeutic goals within the recommended time. Mortality benefit was not statistically significant between groups; however mortality was higher in the non-SRT group.
  
  
  CONCLUSIONS
  Noncompliance is more complex than simple failure to initiate, especially in time-dependent therapies. The development and education of an RT demonstrates improvement in application of sepsis-focused therapies over standard care.
authors.affiliation: Wesley Medical Center, Wichita, Kansas, USA. gberg@kumc.ed
authors.forename: Gina M
authors.initials: GM
authors.lastname: Berg
authors.forename: Donald G
authors.initials: DG
authors.lastname: Vasquez
authors.forename: LaDonna S
authors.initials: LS
authors.lastname: Hale
authors.forename: Sue M
authors.initials: SM
authors.lastname: Nyberg
authors.forename: David A
authors.initials: DA
authors.lastname: Moran
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D055317:Evidence-Based Practice / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D012720:Severity of Illness Index; D059039:Standard of Care / Q000592:standards / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers; D013997:Time Factors; D014193:Trauma Centers