PURPOSE: To evaluate the effect of initiation of "sepsis protocol" and adherence to "sepsis protocol" on hospital mortality of patients admitted to medical intensive care unit at Abington Memorial Hospital(AMH).The secondary end points included differences in length of ICU and hospital stay between "on-hours" and "off-hours".
METHODS: A retrospective chart review was conducted from January to December 2009 of patients admitted to AMH emergency room (ER) with a diagnosis of sepsis after a "sepsis protocol" was initiated at AMH. Patients admitted to the ER from 7:00 am to 7:00 pm from Monday to Friday were included in the "on-hours" group and those admitted from 7:00 PM to 7:00 AM on weekdays and on weekends were included in the "off-hours" group. Adherence to "sepsis protocol" was defined as meeting all below mentioned criteria viz. time to administration of antibiotics <2 hours; blood cultures x 2 before initiating antibiotics; critical care notification <30 minutes; two large bore peripheral intravenous lines able to administer 500 cc NSS in 15-20 minutes and adequate intravenous fluids (30 ml/kg).
RESULTS: "Sepsis protocol" was initiated in a total of 81 patients. Mean APACHE-II score was 17.6±6.6. Adherence to sepsis guidelines was 81% (84% during "on-hours ";83 % during "off-hours"). Overall mortality was 26% (29% during "on-hours"; 24% during"off-hours" ;p=0.63). Mean duration of hospital stay was 10.5±8 days(10.6±7 days during "on-hours";10.4±9 days during "off-hours";p=0.91). Mean ICU length of stay was 4.5±4 days(5±5 days during "on-hours" ;4±3.5 days during "off-hou(rs";p=0.618).
CONCLUSION: Initiation of "sepsis protocol" as an institutional policy led to significant improvement in hospital mortality of septic patients. There were no differences in adherence to sepsis guidelines, hospital and ICU length of stays among patients admitted during "on-hours' vs "off -hours", emphasizing efficient staffing at AMH which minimized diurnal and weekend variations.
CLINICAL IMPLICATIONS: These results reflect the importance of having an institution wide "sepsis protocol" to standardize care of septic patients. Adherence to "sepsis protocol" was noted to be an important factor in improving survival among septic patients.
DISCLOSURE: Nutan Bhaskar, No Financial Disclosure Information; No Product/Research Disclosure Information