title: Impact of Compliance with a Sepsis Resuscitation Bundle in a Portuguese Emergency Department.
abstract: BACKGROUND
  Severe sepsis and septic shock are common conditions with high levels of morbi-mortality surpassing those of coronary heart disease or stroke. The reality of hospital treated sepsis is largely unknown outside of the intensive care unit. We therefore aimed to evaluate the level of compliance with the Surviving Sepsis Campaign 6-hour bundle in a Portuguese emergency department and to relate it to the patient clinical outcomes.
  
  
  METHODS
  We conducted a retrospective, observational cohort study with 178 severe sepsis/septic shock patients admitted to the intensive and intermediate care unit between January 1st 2012 and December 31st 2012.
  
  
  RESULTS
  In the study, period septic shock was diagnosed in 100 patients (56.2%) and severe sepsis in 78 patients (43.8%). Compliance with the sepsis bundle was: (1) 62.9% for lactate measurement; (2) 62.9% for blood cultures before antibiotics; (3) 41.6% for antibiotics in the first 3 hours; (4) 76.4% for fluid administration; (5) 25% for vasopressor administration; (6) 37% for central venous pressure measurement and (7) 39% for central venous oxygen saturation measurement. Full compliance was observed in 22% of the patients. The individual bundle measure - Blood cultures before antibiotics - was significantly associated with a decreased risk of both intensive care unit mortality and 28-day mortality. There was also a trend for an inverse correlation between increased compliance with the full bundle and the intensive care unit and 28-days hospital mortality.
  
  
  CONCLUSIONS
  There was a low compliance with the Surviving Sepsis Campaign 6-hour bundle, a result that replicates the findings in similar international studies. The explanation is complex but it may include the lack of institutional quality monitoring in the emergency department.
  
  
  CONCLUSIONS
  The compliance with a sepsis resuscitation bundle starting in the emergency department was positively associated with the outcomes of the septic patients. Nonetheless the bundle was unreliably performed.
authors.affiliation: Centro Hospitalar de Trás-os-Montes e Alto Douro.
authors.forename: Joao Miguel
authors.initials: JM
authors.lastname: Carvas
authors.affiliation: Centro Hospitalar de Trás-os-Montes e Alto Douro.
authors.forename: Cátia
authors.initials: C
authors.lastname: Canelas
authors.affiliation: Centro Hospitalar de Trás-os-Montes e Alto Douro.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Montanha
authors.affiliation: Sciences School. Universidade do Minho. Guimarães.
authors.forename: Carlos
authors.initials: C
authors.lastname: Silva
authors.affiliation: Centro Hospitalar de Trás-os-Montes e Alto Douro.
authors.forename: Francisco
authors.initials: F
authors.lastname: Esteves
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles; D011174:Portugal; D012151:Resuscitation / Q000592:standards*; D012189:Retrospective Studies; D018805:Sepsis / Q000628:therapy*