Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED - 14/12/15

Doi : 10.1016/j.ajem.2015.08.039

Geoffrey E. Hayden, MD ^a,^{^⁎} , Rachel E. Tuuri, MD ^b, Rachel Scott, MD ^a, Joseph D. Losek, MD ^b, Aaron M. Blackshaw ^c, Andrew J. Schoenling ^c, Paul J. Nietert, PhD ^d, Greg A. Hall, MD ^a
^a 169 Ashley Ave, Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425
^b 135 Rutledge Ave, Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425
^c 96 Jonathan Lucas St, College of Medicine, Medical University of South Carolina, Charleston, SC, 29425
^d 135 Cannon St, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425

^⁎Corresponding author at: Division of Emergency Medicine, Medical University of South Carolina, 169 Ashley Ave, MSC 300, Room 265E, Charleston, SC, 29425.Division of Emergency Medicine, Medical University of South Carolina169 Ashley Ave, MSC 300, Room 265ECharlestonSC29425

Abstract

Background

Early identification of sepsis in the emergency department (ED), followed by adequate fluid hydration and appropriate antibiotics, improves patient outcomes.

Objectives

We sought to measure the impact of a sepsis workup and treatment protocol (SWAT) that included an electronic health record (EHR)–based triage sepsis alert, direct communication, mobilization of resources, and standardized order sets.

Methods

We conducted a retrospective, quasiexperimental study of adult ED patients admitted with suspected sepsis, severe sepsis, or septic shock. We defined a preimplementation (pre-SWAT) group and a postimplementation (post-SWAT) group and further broke these down into SWAT A (septic shock) and SWAT B (sepsis with normal systolic blood pressure). We performed extensive data comparisons in the pre-SWAT and post-SWAT groups, including demographics, systemic inflammatory response syndrome criteria, time to intravenous fluids bolus, time to antibiotics, length-of-stay times, and mortality rates.

Results

There were 108 patients in the pre-SWAT group and 130 patients in the post-SWAT group. The mean time to bolus was 31 minutes less in the postimplementation group, 51 vs 82 minutes (95% confidence interval, 15-46; P value < .01). The mean time to antibiotics was 59 minutes less in the postimplementation group, 81 vs 139 minutes (95% confidence interval, 44-74; P value < .01). Segmented regression modeling did not identify secular trends in these outcomes. There was no significant difference in mortality rates.

Conclusions

An EHR-based triage sepsis alert and SWAT protocol led to a significant reduction in the time to intravenous fluids and time to antibiotics in ED patients admitted with suspected sepsis, severe sepsis, and septic shock.

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Plan

Background

Methods

Design, setting, and population

☆	The authors have no commercial associations or sources of support that might pose a conflict of interest. No source of support for this study.
☆☆	Dr. Nietert’s time is funded in part by a grant from the National Center for Advancing Translational Sciences (award number UL1 TR000062).