title: Initial, successful implementation of sepsis guidelines in an emergency department.
abstract: BACKGROUND
  Early screening and treatment of sepsis can reduce mortality. Region Zealand established guidelines for the diagnosis and treatment of sepsis. We assess an interdisciplinary intervention for implementation of these guidelines at the Department of Emergency Medicine at Nykøbing Falster Hospital from July 2009 to August 2010.
  
  
  METHODS
  Structured training was imparted to personnel during the first 18 weeks. Electronically accessible guidelines, posters with diagnostic and treatment algorithms, pocket references and checklists were made available to encourage adherence to the guidelines. Key nurses and doctors encouraged compliance. Journal audits (at baseline, 18 weeks and one year) were undertaken to measure adherence to six elements of the sepsis guidelines: lactate measurement, oxygen and fluid treatment, timely antibiotic treatment, blood culture and planning of treatment monitoring.
  
  
  RESULTS
  A total of 27 (baseline), 29 (18 weeks) and 48 (one year) patients were included for analysis. Adherence to 3-5 of the elements of the sepsis guidelines' six elements increased from 37% to 65% from baseline to the first follow-up at 18 weeks (p = 0.03). Adherence to 3-5 of the elements decreased from the first to the second follow-up at one year. Lactate measurement, blood culture and antibiotic administration increased from baseline to the one-year follow-up.
  
  
  CONCLUSIONS
  The intervention had a positive effect on the implementation of guidelines. This effect was reduced one year after the baseline audit, possibly due to a decline in the focus on the intervention and/or personnel turnover in the department.
authors.affiliation: Department of Anaesthesia and Emergency Medicine, Nykøbing Falster Hospital, Denmark. mzpl@hotmail.dk
authors.forename: Morten Z
authors.initials: MZ
authors.lastname: Plambech
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Lurie
authors.forename: Helle L
authors.initials: HL
authors.lastname: Ipsen
mesh_terms: D001291:Attitude of Health Personnel; D003718:Denmark; D042241:Early Diagnosis; D004635:Emergency Medicine / Q000193:education; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D058996:Quality Improvement; D018805:Sepsis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome