title: Pilot study comparing sepsis management with and without electronic clinical practice guidelines in an academic emergency department.
abstract: BACKGROUND
  Sepsis is a potentially life-threatening condition that requires urgent management in an Emergency Department (ED). Evidence-based guidelines for managing sepsis have been developed; however, their integration into routine practice is often incomplete. Care maps may help clinicians meet guideline targets more often.
  
  
  OBJECTIVE
  To determine if electronic clinical practice guidelines (eCPGs) improve management of patients with severe sepsis and septic shock (SS/SS).
  
  
  METHODS
  The impact of an eCPG on the management of patients presenting with SS/SS over a 3-year period at a tertiary care ED was evaluated using retrospective case-control design and chart review methods. Cases and controls, matched by age and sex, were chosen from an electronic database using physician sepsis diagnoses. Data were compared using McNemar tests or paired t-tests, as appropriate.
  
  
  RESULTS
  Overall, 51 cases and controls were evaluated; the average age was 62 years, and 60% were male. eCPG patients were more likely to have a central venous pressure and central venous oxygen saturation measured; however, lactate measurement, blood cultures, and other investigations were similarly ordered (all p > 0.05). The administration of antibiotics within 3 h (63% vs. 41%; p = 0.03) and vasopressors (45% vs. 20%; p = 0.02) was more common in the eCPG group; however, use of corticosteroids and other interventions did not differ between the groups. Overall, survival was high and similar between groups.
  
  
  CONCLUSIONS
  A sepsis eCPG experienced variable use; however, physicians using the eCPG achieved more quality-of-care targets for SS/SS. Strategies to increase the utilization of eCPGs in Emergency Medicine seem warranted.
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bond
authors.forename: Dennis
authors.initials: D
authors.lastname: Djogovic
authors.forename: Cristina
authors.initials: C
authors.lastname: Villa-Roel
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bullard
authors.forename: David P
authors.initials: DP
authors.lastname: Meurer
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010865:Pilot Projects; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D017410:Practice Guidelines as Topic; D018805:Sepsis / Q000188:drug therapy / Q000628:therapy*; D012772:Shock, Septic / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin