title: Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED.
abstract: BACKGROUND
  Early identification of sepsis in the emergency department (ED), followed by adequate fluid hydration and appropriate antibiotics, improves patient outcomes.
  
  
  OBJECTIVE
  We sought to measure the impact of a sepsis workup and treatment protocol (SWAT) that included an electronic health record (EHR)-based triage sepsis alert, direct communication, mobilization of resources, and standardized order sets.
  
  
  METHODS
  We conducted a retrospective, quasiexperimental study of adult ED patients admitted with suspected sepsis, severe sepsis, or septic shock. We defined a preimplementation (pre-SWAT) group and a postimplementation (post-SWAT) group and further broke these down into SWAT A (septic shock) and SWAT B (sepsis with normal systolic blood pressure). We performed extensive data comparisons in the pre-SWAT and post-SWAT groups, including demographics, systemic inflammatory response syndrome criteria, time to intravenous fluids bolus, time to antibiotics, length-of-stay times, and mortality rates.
  
  
  RESULTS
  There were 108 patients in the pre-SWAT group and 130 patients in the post-SWAT group. The mean time to bolus was 31 minutes less in the postimplementation group, 51 vs 82 minutes (95% confidence interval, 15-46; P value < .01). The mean time to antibiotics was 59 minutes less in the postimplementation group, 81 vs 139 minutes (95% confidence interval, 44-74; P value < .01). Segmented regression modeling did not identify secular trends in these outcomes. There was no significant difference in mortality rates.
  
  
  CONCLUSIONS
  An EHR-based triage sepsis alert and SWAT protocol led to a significant reduction in the time to intravenous fluids and time to antibiotics in ED patients admitted with suspected sepsis, severe sepsis, and septic shock.
authors.affiliation: 169 Ashley Ave, Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425. Electronic address: haydeng@musc.edu.
authors.forename: Geoffrey E
authors.initials: GE
authors.lastname: Hayden
authors.affiliation: 135 Rutledge Ave, Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Tuuri
authors.affiliation: 169 Ashley Ave, Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425.
authors.forename: Rachel
authors.initials: R
authors.lastname: Scott
authors.affiliation: 135 Rutledge Ave, Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Losek
authors.affiliation: 96 Jonathan Lucas St, College of Medicine, Medical University of South Carolina, Charleston, SC, 29425.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Blackshaw
authors.affiliation: 96 Jonathan Lucas St, College of Medicine, Medical University of South Carolina, Charleston, SC, 29425.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schoenling
authors.affiliation: 135 Cannon St, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nietert
authors.affiliation: 169 Ashley Ave, Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425.
authors.forename: Greg A
authors.initials: GA
authors.lastname: Hall
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002985:Clinical Protocols; D057286:Electronic Health Records; D004636:Emergency Service, Hospital; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D014218:Triage
chemical_list: D000900:Anti-Bacterial Agents