title: Implementation of modified early-goal directed therapy for sepsis in the emergency center of a comprehensive cancer center.
abstract: OBJECTIVE
  The investigation examines the impact of a standardized sepsis order set and algorithm utilizing non-invasive monitoring for early-goal directed therapy (EGDT) in an emergency center setting on the clinical outcomes of sepsis in cancer patients.
  
  
  METHODS
  Single-center, retrospective study comparing clinical outcomes of sepsis before and after routine usage of a standardized order set and algorithm for non-invasive elements of EGDT for sepsis in an emergency center of a comprehensive cancer center. The outcomes measures evaluated were 28-day in-hospital mortality, intensive care unit length of stay, hospital length of stay, goal mean arterial pressure and urine output within the first 6 h of treatment, time to measurement of lactic acid, and appropriateness and timeliness of initial antibiotic therapy.
  
  
  RESULTS
  The 28-day in-hospital mortality was significantly lower in the post-intervention group compared to the pre-intervention group (20 vs. 38%, p = 0.005). The percentages of patients who reached their goal mean arterial pressure (74 vs. 90%, p = 0.004) and goal urine output (79 vs. 96%, p = 0.002) during the first 6 h of treatment were higher the after than the before group. No significant differences were detected in the rest of the outcome measures.
  
  
  CONCLUSIONS
  Implementation of a standardized sepsis order set and algorithm to improve compliance with the non-invasive elements of EGDT for sepsis in cancer patients in the emergency center setting was associated with a decreased 28-day in-hospital mortality rate.
authors.affiliation: Division of Pharmacy, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. khanzelka@mdanderson.org
authors.forename: Katy M
authors.initials: KM
authors.lastname: Hanzelka
authors.forename: Sai-Ching J
authors.initials: SC
authors.lastname: Yeung
authors.forename: Gary
authors.initials: G
authors.lastname: Chisholm
authors.forename: Kelly Willis
authors.initials: KW
authors.lastname: Merriman
authors.forename: Susan
authors.initials: S
authors.lastname: Gaeta
authors.forename: Imrana
authors.initials: I
authors.lastname: Malik
authors.forename: Terry W
authors.initials: TW
authors.lastname: Rice
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001794:Blood Pressure; D002173:Cancer Care Facilities / Q000458:organization & administration*; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018805:Sepsis / Q000628:therapy*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents