Multifaceted interventions to decrease mortality in patients with severe sepsis/septic shock-a quality improvement project.
Despite knowledge that EGDT improves outcomes in septic patients, staff education on EGDT and compliance with the CPOE order set has been variable. Based on results of a resident survey to identify barriers to decrease severe sepsis/septic shock mortality in the medical intensive care unit (MICU), multifaceted interventions such as educational interventions to improve awareness to the importance of early goal-directed therapy (EGDT), and the use of the Computerized Physician Order Entry (CPOE) order set, were implemented in July 2013. CPOE order set was established to improve compliance with the EGDT resuscitation bundle elements. Orders were reviewed and compared for patients admitted to the MICU with severe sepsis/septic shock in July and August 2013 (controls) and 2014 (following the intervention). Similarly, educational slide sets were used as interventions for residents before the start of their ICU rotations in July and August 2013. While CPOE order set compliance did not significantly improve (78% vs. 76%, p = 0.74), overall EGDT adherence improved from 43% to 68% (p = 0.0295). Although there was a trend toward improved mortality, this did not reach statistical significance. This study shows that education interventions can be used to increase awareness of severe sepsis/septic shock and improve overall EGDT adherence.
Department of Internal Medicine, Mayo Clinic , Rochester, MN , United States.
Brittany
B
Siontis
Department of Pulmonary & Critical Care, Mayo Clinic , Rochester, MN , United States.
Jennifer
J
Elmer
Department of Pulmonary & Critical Care, Mayo Clinic , Rochester, MN , United States.
Richard
R
Dannielson
Department of Pulmonary & Critical Care, Mayo Clinic , Rochester, MN , United States.
Catherine
C
Brown
Department of Pulmonary & Critical Care, Mayo Clinic , Rochester, MN , United States.
John
J
Park
Division of Pulmonary, Critical Care & Sleep Medicine, Texas A&M University , Corpus Christi, TX , United States.
Salim
S
Surani
Division of Pulmonary and Critical Care, Mayo Clinic , Rochester, MN , United States.
Kannan
K
Ramar
Critical care; ICU; ICU mortality; Quality initiative; Sepsis; Surviving sepsis