interesting article

phiposurde · Jun 27, 2007

Accession Number

00003246-200704000-00016.

AuthorNguyen, H Bryant MD, MS; Corbett, Stephen W. MD, PhD; Steele, Robert MD; Banta, Jim PhD, MPH; Clark, Robin T. BS; Hayes, Sean R.; Edwards, Jeremy; Cho, Thomas W. MD; Wittlake, William A. MD

TitleImplementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality *.[Article]

SourceCritical Care Medicine. 35(4):1105-1112, April 2007.

AbstractObjective: The purpose of this study was to examine the outcome implications of implementing a severe sepsis bundle in an emergency department as a quality indicator set with feedback to modify physician behavior related to the early management of severe sepsis and septic shock.

Design: Two-year prospective observational cohort.

Setting: Academic tertiary care facility.

Patients: Patients were 330 patients presenting to the emergency department who met criteria for severe sepsis or septic shock.

Interventions: Five quality indicators comprised the bundle for severe sepsis management in the emergency department: a) initiate central venous pressure (CVP)/central venous oxygen saturation (Scvo2) monitoring within 2 hrs; b) give broad-spectrum antibiotics within 4 hrs; c) complete early goal-directed therapy at 6 hrs; d) give corticosteroid if the patient is on vasopressor or if adrenal insufficiency is suspected; and e) monitor for lactate clearance.

Measurements and Main Results: Patients had a mean age of 63.8 +/- 18.5 yrs, Acute Physiology and Chronic Health Evaluation II score 29.6 +/- 10.6, emergency department length of stay 8.5 +/- 4.4 hrs, hospital length of stay 11.3 +/- 12.9 days, and in-hospital mortality 35.2%. Bundle compliance increased from zero to 51.2% at the end of the study period. During the emergency department stay, patients with the bundle completed received more CVP/Scvo2 monitoring (100.0 vs. 64.8%, p

Conclusions: Implementation of a severe sepsis bundle using a quality improvement feedback to modify physician behavior in the emergency department setting was feasible and was associated with decreased in-hospital mortality.

DOI Number10.1097/01.CCM.0000259463.33848.3D