To investigate the impact of resident-focused education and the introduction of the Rapid Response Team (RRT) on the outcomes of severe sepsis patients admitted to the general medical floors (GMFs) at a community hospital. We also set out to evaluate compliance to treatment protocol.
A retrospective study of patients with a RRT evaluation screened for severe sepsis from November - December 2007. The RRT was introduced in February 2007 comprising a senior medicine resident, physician assistant, critical care trained nurse and respiratory therapist. Education of the residents included SSC guidelines pocket card, electronic order sets and didactics. The primary outcomes were 30-day mortality and compliance to the Surviving Sepsis Campaign (SSC) guidelines.
A total of 45 patients fulfilled severe sepsis or septic shock criteria. The average age was 73.2 years with 26 (58%) patients admitted from nursing homes. In 20 (44%) patients, cultures grew either Multi-drug resistant (MDR) gram negative, MRSA or VRE.Most patients (98%) received intravenous fluid resuscitation while 23 (51%) patients required vasopressor support; stress-dose steroids were administered for 29 (64%) patients. Serum lactate was drawn in 43 (96%) patients.Overall 30-day mortality for our patient cohort was 64%. For 26 (58%) patients with Do-Not-Resuscitate (DNR) status mortality was 81% while Full Code patients had 42% mortality. Mortality of all severe sepsis patients at our hospital from November-December 2007 and 2008, based on the diagnosis-related group system, was 58% and 47% respectively.
A high compliance rate to SSC guidelines was seen in parameters evaluated. Further effort should be made to evaluate compliance to antibiotic therapy and central venous pressure monitoring. The high mortality rate of our cohort was skewed by a large number of DNR patients and a sicker sample population requiring a RRT evaluation.
Patients with severe sepsis on GMFs have high mortality. Education, multidisciplinary team approach and compliance with SSC guidelines may lead to better outcomes.
Avinesh Bhar, No Financial Disclosure Information; No Product/Research Disclosure Information