Using quality improvement principles to improve the care of patients with severe sepsis and septic shock.
BACKGROUND
Sepsis, an inflammatory response to an infection that may lead to severe organ dysfunction and death, is the leading cause of death in medical intensive care units. The Society of Critical Care Medicine has issued guidelines and promoted protocols to improve the management of patients with severe sepsis and septic shock. Generally, the medical community has been slow to adopt these guidelines because of the system challenges associated with protocol implementation. We describe an interdisciplinary team approach to the development and implementation of management protocols for treating patients with severe sepsis and septic shock.


METHODS
To determine the effectiveness of the bundled emergency department and critical care order sets developed by the Sepsis Steering Committee, we performed a case review of 1,105 sequential patients admitted to a large academic tertiary referral hospital with a diagnosis of severe sepsis or septic shock between July 2008 and January 2012.


RESULTS
Implementation of the protocol led to improved order set use over time, a significant decrease in the median time to antibiotics of 140 (range 1-820) minutes in 2008 to 72 (range 1-1,020) minutes in 2011 (P≤0.001), and a decrease in median length of stay from 8 days (range 1-54) in 2008 to 7 days (range 1-33) in 2011 (P=0.036).


CONCLUSIONS
A multidisciplinary team approach to sepsis management using protocols and early goal-directed therapy is feasible in a large academic medical center to improve the process of care and outcomes.
Department of Pulmonary and Critical Care Medicine, Ochsner Clinic Foundation ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans.
Leonardo
L
Seoane
Fiona
F
Winterbottom
Teresa
T
Nash
Jessica
J
Behrhorst
Elen
E
Chacko
Lucas
L
Shum
Andrey
A
Pavlov
David
D
Briski
Shelley
S
Thibeau
Dominique
D
Bergeron
Tiffany
T
Rafael
Erik
E
Sundell
Quality improvement; sepsis; shock–septic