Document Detail

Early goal-directed therapy: improving mortality and morbidity of sepsis in the emergency department.
MedLine Citation:
PMID:  19435157     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The growing number of patients with severe sepsis or septic shock and the resulting mortality rate (30%) require changes in the current protocols used to treat these conditions. Through adaptation of early goal-directed therapy (EGDT), Carolinas Medical Center developed a process improvement strategy for decreasing mortality associated with severe sepsis and septic shock. Before implementing the EDGT protocol, the ED did not follow a written management protocol for septic patients. METHODS: Following establishment of an interdisciplinary team, several process improvement activities were conducted, including the development of a standardized algorithm and treatment protocol, a physician order sheet, a nursing flow sheet, and a code sepsis response team. RESULTS: A total of 381 patients were enrolled: 79 in the pre-intervention phase and 302 in the postintervention phase. Mortality rates decreased from 27% pre-intervention to 19% postintervention (-8% absolute mortality; 95% confidence interval [C.I.], 7-9; p = .2138). There were significant differences between the pre- and postintervention groups for endotracheal intubation (17%, p = .0012), crystalloid infusion (1.4 L, p < .0001), vasopressor administration (33%, p < .0001), and packed red blood cells (34%, p < .0001). Both groups were generally similar in their demographics, comorbidities, and vital signs. DISCUSSION: As a result of this process improvement initiative, patients who might have received delayed and/or inadequate treatment for severe sepsis or septic shock are now receiving effective, life-saving treatment. Because of the emphasis on training, consistency in applying the protocol, relatively few changes in current ED practice, and low direct expenditures for equipment, the protocol can be easily integrated into existing ED environments to allow hospitals to quickly implement this successful, best-practice program.
Anne Focht; Alan E Jones; Timothy J Lowe
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Joint Commission journal on quality and patient safety / Joint Commission Resources     Volume:  35     ISSN:  1553-7250     ISO Abbreviation:  -     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-05-13     Completed Date:  2009-06-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101238023     Medline TA:  Jt Comm J Qual Patient Saf     Country:  United States    
Other Details:
Languages:  eng     Pagination:  186-91     Citation Subset:  IM    
Pulmonary and Critical Care Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA.
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MeSH Terms
Case-Control Studies
Clinical Protocols*
Emergency Service, Hospital / standards*
Hospital Bed Capacity, 500 and over
Hospital Mortality
Hospitals, Public
Middle Aged
North Carolina / epidemiology
Outcome Assessment (Health Care)
Prospective Studies
Shock, Septic / mortality,  therapy*
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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