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Abstract

Introduction: Following Surviving Sepsis Campaign (SSC) guidelines with rapid recognition and aggressive intervention of septic shock dramatically improves outcome. Recent studies suggest that many hospitals are less than 25% compliant with the suggested treatment guidelines. A sepsis team has been created in our institution in order to increase compliance with SSC guidelines. Hypothesis: The objective of this study was to investigate whether the implementation of sepsis team increased compliance with guidelines and improved outcomes in patients with septic shock. Methods: This study was completed at a large University-affiliated hospital on patients with septic shock before (n = 241) and after (n = 358) implementation of sepsis team between July 2010 and August 2012 (Sepsis team was implemented starting July 2011). Data elements were prospectively collected on all septic shock patients. Results: Sepsis resuscitation bundle compliance within 6 hours improved from pre- to post- sepsis team as follows respectively: serum lactate from 65% to 94% (Odds Ratio [OR], 8.3; 95 % confidence interval [CI], 5.0-13.8; p < 0.0001), fluid resuscitation 20 ml/kg from 71% to 94% (OR, 7.0; 95% CI, 4.0-12.0; p < 0.0001), central venous pressure (CVP) of at least 8 mmHg from 23% to 42% (OR, 2.5; 95% CI, 1.5-4.2; p < 0.0001), and central venous oxygen saturation (ScvO2) of 70% from 20% to 29% (OR, 1.6; 95% CI, 1.0-3.0; p = 0.09). ICU mortality for severe sepsis decreased from 28% to 14.5% (OR, 2.3; 95% CI, 1.3-4.1; p < 0.01), and for septic shock decreased from 46.7% to 18.5% (OR, 3.9; 95% CI, 2.3-6.5, p < 0.0001). Average ICU length of stay decreased from 8.16 to 3.43 days (p < 0.05). This resulted in decrease in direct cost per patient from $12,009 to $9,252. Conclusions: Implementation of multidisciplinary sepsis team lead to substantial improvement in compliance with the sepsis resuscitation bundle. This in turn lead to statistically improved outcomes, notably mortality and ICU length of stay in severe sepsis and septic shock patients. Compliance with individual sepsis bundle elements has improved but opportunity for significant continued improvement still exists.