PURPOSE: Sepsis is responsible for 215,000 deaths per year and the Surviving Sepsis Campaign was initiated to standardize care and improve outcomes in this patient population. We previously reported on reduced sepsis mortality (CCM 2006, Vol. 34, A2 & A108) in our ICU patients and we hypothesized that the improvement in outcomes correlated with the development of a centralized process for identifying sepsis patients and implementing the sepsis bundle in a more timely fashion during the same time period.
METHODS: We screened high risk patients in eight hospitals (118 ICU beds) from our eICU® center. When patients were identified who met sepsis criteria they were then tracked for compliance with the sepsis bundle. The eICU physician would either implement the bundle (order blood cultures, baseline labs, measure lactate and administer antibiotics within 2 hours) if given the authority (high category of intervention) or would contact the attending physician and advise for timely bundle implementation. Data was extracted and analyzed by nptrend and reports were provided back to the facilities on a monthly basis.
RESULTS: 8116 of 8134 ICU admissions were screened from Jan-Nov 2006 (99.8%), and of those screened 1120 patients met criteria for sepsis (13.8%). Sepsis bundle implementation showed the following changes over the 11 months: Antibiotics within 2 hours went from 51% to 79% (p<.001), blood cultures drawn before antibiotics from 63% to 74% (p<.001), lactate measurement from 49% to 55% (p=.07), and baseline labs from 78% to 84% (p=.003).
CONCLUSION: Accurate sepsis identification can be achieved from a central location and correlates with both improved sepsis bundle compliance and reduced mortality.
CLINICAL IMPLICATIONS: Centralized remote identification of at-risk patients may be beneficial for improving adherence to best practices for identification and management of sepsis as well as other common conditions.
DISCLOSURE: Teresa Rincon, No Product/Research Disclosure Information; Consultant fee, speaker bureau, advisory committee, etc. Eli Lilly Medical Advisory Board and Speaker Bureau