PURPOSE: We sought to determine whether a protocol based on the Surviving Sepsis Campaign Guidelines (Crit Care Med 2004;32:858-73) could decrease mortality in septic shock at our community teaching hospital.
METHODS: We developed the Slay Sepsis Protocol based on the Surviving Sepsis guidelines, using a mixed emergency department(ED)-ICU model of care. Patients were identified and entered into the protocol in the ED. The first few hours of care occurred in the ED, and then patients were rapidly transferred to ICU where a Sepsis Team of medical housestaff led by an intensivist continued resuscitation and further management according to the protocol. We prospectively identified and followed all septic shock patients entered into the protocol over seven months from September 1, 2005 to March 31, 2006 (T). We then compared the mortality outcomes to a historical control group (C) of septic shock patients identified via our Project Impact Database for the six month period preceding the institution of the protocol .
RESULTS: C and T groups had similar APACHE II scores: C group (n=16) had a mean and median Apache II score of 25.4 and 24 respectively, T group (n=38, including 4 transferred from medical floors) had a mean and median Apache II score of 26.2 and 25 respectively. The mortality of C group was 40%, and the mortality of T group was 21%.
CONCLUSION: Institution of a sepsis protocol in a community teaching hospital is feasible, and results in significant reduction of mortality in septic shock.
CLINICAL IMPLICATIONS: A mixed ED-ICU model of a sepsis protocol is effective, and can significantly reduce mortality of septic shock.
DISCLOSURE: Priti Gagneja, None.