Effects on management and outcome of severe sepsis and septic shock patients admitted to the intensive care unit after implementation of a sepsis program: a pilot study

Massimo Girardis, Laura Rinaldi, Lara Donno, Marco Marietta, Mauro Codeluppi, Patrizia Marchegiano, Claudia Venturelli, Sopravvivere alla Sepsi Group of the Modena-University Hospital, Massimo Girardis, Laura Rinaldi, Lara Donno, Marco Marietta, Mauro Codeluppi, Patrizia Marchegiano, Claudia Venturelli, Sopravvivere alla Sepsi Group of the Modena-University Hospital

Abstract

Introduction: The application in clinical practice of evidence-based guidelines for the management of patients with severe sepsis/septic shock is still poor in the emergency department, while little data are available for patients admitted to the intensive care unit (ICU). The aim of this study was to evaluate the effect of an in-hospital sepsis program on the adherence to evidence-based guidelines and outcome of patients with severe sepsis/septic shock admitted to the ICU.

Methods: This prospective observational cohort study included 67 patients with severe sepsis/septic shock admitted to a multidisciplinary ICU at a University Hospital from January 2005 to June 2007. Compliance to 5 resuscitation and 4 management sepsis interventions and in-hospital mortality were measured following an educational program on sepsis for physician and nurses of all hospital departments and hospital implementation of a specific protocol for recognition and management of patients with severe sepsis/septic shock, including an early consultation by a skilled 'sepsis team'.

Results: During the study period, the compliance to all 9 interventions increased from 8% to 35% of the patients (P < 0.01). The implementation of resuscitation and management interventions was associated with a lower risk of in-hospital mortality (23% vs 68% and 27% vs 68%, P < 0.01). In the latter 2 semesters, after activation of the 'sepsis team', in-hospital mortality of ICU septic shock patients decreased by about 40% compared with the previous period (32% vs 79%, P < 0.01).

Conclusions: In our experience, an in-hospital sepsis program, including education of health-care personnel and process-changes, improved the adherence to guidelines and the survival rate of patients with severe sepsis/septic shock admitted to the ICU.

Figures

Figure 1
Figure 1
Mortality of patients with (black column) and without (white column) implementation of 6-hours bundle, 24-hours bundle and all interventions. For each group of patients the predicted mortality by simplified acute physiology score (SAPS) II is also reported (dotted line). * P < 0.05 comparing patients with and without bundles compliance.
Figure 2
Figure 2
In-hospital mortality before (white columns) and after (black columns) 'sepsis team' activation (June 2006) in all population and in septic shock patients. For each group of patients, the predicted mortality by simplified acute physiology score (SAPS) II is also reported (dotted line). * P < 0.05 before and after sepsis team activation.

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