Sepsis is a major cause of mortality in our community hospital system. Our goal was to reduce sepsis mortality to less than 35%. We developed a sepsis protocol based on early goal-directed therapy for the treatment of severe sepsis and septic shock. The protocol utilized an ICU order set for all patients who met the SIRS criteria plus hypotension or an elevated lactate level.
We developed and instituted a specific order set for sepsis and septic shock based on the surviving sepsis campaign guidelines. This effort was a collaboration between the medical, nursing, and pharmacy staff. The order set was approved by the Critical Care Committee,the Medical Quality Management Committee, and ultimately the Medical Executive Committee. System wide education was delivered. Data was tracked monthly by chart review of all patients meeting entrance criteria. Compliance and mortality were monitored for all patients who met the entrance criteria above. The data was then presented quarterly in an effort to improve physician compliance with the order set. Open discussion of issues regarding the protocol was encouraged. Noncompliance with the order set was addressed by our peer review process.
Initial mortality averaged 50–60% prior to institution of the protocol. Since initiation of the protocol mortality has been steadily reduced. Mortality remained below our goal of 35% for 4 of the last 6 months. Mortality was inversely related to physician compliance with the order set. See figure 1.
A protocol driven approach to sepsis utilizing a disease specific order set reduces all cause mortality. Our reduction in mortality is directly related to physician compliance with this order set.
Efforts to optimize physician acceptance and increase compliance with an evidence-based sepsis order set saves lives.
Martin Forrest, No Financial Disclosure Information; No Product/Research Disclosure Information