title: SEPSIS KILLS: early intervention saves lives.
abstract: To implement a statewide program for the early recognition and treatment of sepsis in New South Wales, Australia.
  
  
  
  Ninety-seven emergency departments in NSW hospitals.
  
  
  
  A quality improvement program (SEPSIS KILLS) that promoted intervention within 60 minutes of recognition, including taking of blood cultures, measuring serum lactate levels, administration of intravenous antibiotics, and fluid resuscitation.
  
  
  
  Time to antibiotics and fluid resuscitation; mortality rates and length of stay.
  
  
  
  Data for 13 567 patients were entered into the database. The proportion of patients receiving intravenous antibiotics within 60 minutes of triage increased from 29.3% in 2009-2011 to 52.2% in 2013. The percentage for whom a second litre of fluid was started within 60 minutes rose from 10.6% to 27.5% (each P < 0.001). The proportion of patients classed as Australasian Triage Scale (ATS) 1 increased from 2.3% in 2009-2011 to 4.2% in 2013, and the proportion classed as ATS 2 rose from 40.7% in 2009-2011 to 60.7% in 2013 (P < 0.001). There was a linear decrease in mortality from 19.3% in 2009-2011 to 14.1% in 2013; there was also a significant decline in time in intensive care and total length of stay (each P < 0.0001). The mortality rate for patients with severe sepsis (serum lactate ≥ 4 mmol/L or systolic blood pressure [SBP] < 90 mmHg) was 19.7%. The mortality rates for patients with severe sepsis admitted to intensive care and for those admitted to a ward did not change significantly over time. The proportion of patients with uncomplicated sepsis (SBP ≥ 90 mmHg, serum lactate < 4 mmol/L) transferred to a ward increased, and the mortality rate after transfer increased from 3.2% in 2009-2011 to 6.2% in 2013 (P < 0.05). The survival benefit was greatest for patients with evidence of haemodynamic instability (SBP < 90 mmHg) but normal lactate levels (P = 0.03).
  
  
  
  The SEPSIS KILLS program has improved the process of care for patients with sepsis in NSW hospitals. The program has focused attention on sepsis management in the wards.
authors.affiliation: Clinical Excellence Commission, Sydney, NSW m.mclaws@unsw.edu.au,rosemary.sullivan@health.nsw.gov.au.
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Burrell
authors.affiliation: University of New South Wales, Sydney, NSW.
authors.forename: Mary-Louise
authors.initials: ML
authors.lastname: McLaws
authors.affiliation: Clinical Excellence Commission, Sydney, NSW.
authors.forename: Mary
authors.initials: M
authors.lastname: Fullick
authors.affiliation: Clinical Excellence Commission, Sydney, NSW.
authors.forename: Rosemary B
authors.initials: RB
authors.lastname: Sullivan
authors.affiliation: Clinical Excellence Commission, Sydney, NSW.
authors.forename: Doungkamol
authors.initials: D
authors.lastname: Sindhusake
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D001769:Blood / Q000382:microbiology*; D042241:Early Diagnosis; D004636:Emergency Service, Hospital; D005440:Fluid Therapy; D017408:Guidelines as Topic; D006801:Humans; D015994:Incidence; D019344:Lactic Acid / Q000097:blood*; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D019344:Lactic Acid