Implementation of sepsis management guideline in a community-based teaching hospital - can education be potentially beneficial for septic patients?
OBJECTIVE
To assess clinical outcomes associated with the implementation of the sepsis management guideline in a community-based hospital. In addition, evaluate the utility and effectiveness of a Sepsis Education Program.


METHODS
This is an observational cohort study of patients presenting to the Emergency Department at a community-based teaching centre meeting severe sepsis or septic shock criteria. A quality improvement programme consisting of a comprehensive Sepsis Education Program based on recommendations from the Surviving Sepsis Campaign was implemented and evaluated. Patients were identify by the admission diagnosis and were evaluated over two time periods (7/2003-6/2004 and 7/2005-6/2006) and to show clinical outcomes before and after implementation of the sepsis guideline/quality improvement programme.


RESULTS
A total of 96 patients with severe sepsis (34 control group and 62 SSC group) were included. Both groups had similar intensive care unit (ICU)-length of stay (3 vs. 3 days, p = 0.647). Patients who required mechanical ventilation (MV) had similar MV time (4 vs. 3.5 days p = 0.349). A greater percentage of survival was found in the SSC group [45% vs. 73% (p = 0.006)]. Patient received similar care with regards to appropriate early antibiotics (85% vs. 90%, p 0.459). The main difference between the two group was the early fluid resuscitation (2 l vs. 3 l, p = 0.006) over the first 3 h and a difference remained significant at 6 h (4.2 l vs. 6.3 l, p = 0.013).


CONCLUSIONS
In a community based teaching hospital, implementing the surviving sepsis campaign guideline through an education programme was feasible and resulted in early therapy with aggressive fluid administration and appropriate antibiotics. The Sepsis Education Program resulted in early therapeutic interventions and contributed to the survival benefits.
Western University of Health Sciences, College of Pharmacy, Pomona, CA, USA.
H M
HM
Nguyen
A
A
Schiavoni
K D
KD
Scott
M A
MA
Tanios
D018806:APACHE; D000368:Aged; D016022:Case-Control Studies; D003422:Critical Care / Q000458:organization & administration / Q000592:standards; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D005240:Feasibility Studies; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D055552:Infectious Disease Medicine / Q000193:education*; D007902:Length of Stay; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D011446:Prospective Studies; D018805:Sepsis / Q000628:therapy*; D016896:Treatment Outcome