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The Impact of Protocol Based Management of Severe Sepsis and Septic Shock on Clinical Outcomes in a Community Hospital With Emphasis on the 3 Hour Bundle FREE TO VIEW

Mohamed Osman, MD; Souad Enakuaa, MD; Jane Ramos, CCRN; Kim Kresevic, CCRN; Iris Rukshin; Lee Chadrick Chua, MD
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Raritan Bay Medical Center, Perth Amboy, NJ

Chest. 2015;148(4_MeetingAbstracts):349A. doi:10.1378/chest.2267069
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SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Early Goal Directed Therapy (EGDT) boasted a significant mortality reduction by targeting and optimizing select physiological variables in septic patients. As a result, the Surviving Sepsis Campaign (SSC) spearheaded the national movement to implement sepsis care bundles. However, improved clinical outcomes from such measures were sporadic in subsequent trials. Recently, studies like PROCESS and ARISE did not show the robust results seen with EGDT, further challenging the efficacy of protocolized management of sepsis. The ensuing critical analysis suggested early bundle elements, rather than the protocol in its entirety, were possibly the major factors contributing to clinical improvement.

METHODS: A sepsis management protocol based on the SSC 3 and 6 hour care bundles was implemented at Raritan Bay Medical Center (RBMC). The study was conducted from October 2013 to September 2014 and a total 96 patients were enrolled. We retrospectively compared the mortality, ICU, and hospital length of stay (LOS) between the pre- (n=45) versus post- implementation (n=51) of the RBMC sepsis protocol. Additionally, compliance was determined by the completion of all or most of the elements in each of the bundles.

RESULTS: Patients pre-sepsis protocol had an in hospital mortality rate of 40%, with an average hospital LOS of 13.8 days and an average ICU LOS of 9.1 days. After sepsis protocol implementation, hospital mortality rate was 12%, and average hospital and ICU LOS was 10.1 and 4.8 days, respectively. A sub-analysis of vasopressor cohorts showed an in hospital mortality rate of 19%, with an average hospital and ICU LOS of 9.3 and 5.6 days, respectively. Furthermore, compliance within the sepsis protocol group to the 3 hour bundle elements was 47% and 6 hr bundle elements was 17%

CONCLUSIONS: In a community hospital setting, protocol based sepsis management reduced mortality, ICU, and hospital LOS. Additionally, it positively impacted clinical outcomes in the setting of a higher compliance to the 3 hour compared to the 6 hour bundle.

CLINICAL IMPLICATIONS: Reduction in hospital mortality with protocol guided sepsis managment

DISCLOSURE: The following authors have nothing to disclose: Mohamed Osman, Souad Enakuaa, Jane Ramos, Kim Kresevic, Iris Rukshin, Lee Chadrick Chua

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