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Avoiding the Hawthorne Effect in a Large Sepsis Observational Study FREE TO VIEW

Bruce Krieger, MD; Aaron West, MD; Jenel Lengle, RN; Barbara Johnston, RN; Linda Morante, RN; Michelle Bourassa, CCS; Jason Widrich, MD
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Memorial Hospital Jacksonville, Jacksonville, FL

Chest. 2013;144(4_MeetingAbstracts):426A. doi:10.1378/chest.1702784
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SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: To assess the in-hospital mortality differences in patients with septic shock who did and didn’t have the Surviving Sepsis bundles implemented during the same time period at a single institution.

METHODS: This was a prospective, observational, parallel group study in a single institution from 6/1/2010 - 12/31/2012 of 1,101 patients with septic shock (MAP < 65 mmHg despite adequate fluid resuscitation). In 7/2010, sepsis bundle orders were instituted in the Emergency Department and intensive care units (ICU 1, 2, 3). A sepsis coordinator (starting 11/2010) organized intense educational activities for all nurses, therapists, pharmacists, and physicians and prospectively collected data. All ICU’s had the same staff, had the same screening and order systems, and had access to the same 24 hour coverage by mid-level intensivists. Computerized sepsis screening was performed on all patients every 12 hours. Positive screens were reported to the critical care teams (CCT) who ultimately decided on whether to institute the bundle. ICU 1 and 2 were staffed by a CCT that utilized the bundle in 92% of septic shock patients while most patients in CC 3 were cared for by a CCT that used the bundle in 25% of identified patients.

RESULTS: Septic shock was recognized in 999 patients in ICU 1 - 2 and 102 patients in ICU 3. The mortality rate for ICU 1 - 2 septic shock patients was 35% vs. 55% in ICU 3 (relative risk reduction of 36%; 95% CI: 17-51; p < 0.01). The case mix index (severity of illness measure) was similar (3.945 vs. 4.034, p > 0.1).

CONCLUSIONS: Since all variables associated with the Hawthorne effect were identical in ICU 1-2 vs. ICU 3 patients (personnel, training, sepsis screening, access to line placement, order sets, pharmacy, time period) except for physician acceptance, the significant difference in mortality was attributed to failure to implement the sepsis bundle.

CLINICAL IMPLICATIONS: Mortality from septic shock can be significantly reduced when the Surviving Sepsis bundles are implemented.

DISCLOSURE: The following authors have nothing to disclose: Bruce Krieger, Aaron West, Jenel Lengle, Barbara Johnston, Linda Morante, Michelle Bourassa, Jason Widrich

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