Emergency Physician Compliance with Quality Indicators of Septic Shock and Severe Sepsis in Eastern Taiwanese Community Hospital.

Abstract

A retrospective review was conducted, examining patient charts at a community hospital in Eastern Taiwan during a 2-year period, from April 2013 to March 2015. The goal was assessment of adherence to quality indicators (QIs) in septic shock and severe sepsis (4S status) by emergency physicians (EPs). Based on the Surviving Sepsis Campaign (SSC) guidelines, data was electronically retrieved from the Hospital Information System (HIS); and beginning in April 2014, our staff was regularly educated on this topic during monthly meetings. A Sepsis Bundle Care Set (SBCS) was also launched in September 2014. The Chi-square post hoc test was utilized in statistical analysis, setting signifi cance at p < 0.05. In patients with septic shock (n = 81) or severe sepsis (n = 572), QIs before and after educational initiatives were 36 vs. 45 and 259 vs. 313, respectively. In terms of septic shock, QIs that improved signifi cantly after education were C-reactive protein (CRP: 66.67% vs. 91.11%), arterial blood gas (ABG: 58.33% vs. 80.00%), and intravenous (IV)-fluid infusion rate (0.00% vs. 40.00%). QIs that significantly improved in the context of severe sepsis were CRP (59.46% vs. 84.66%), serum lactate (75.68% vs. 86.26%), intensive care unit (ICU) admission within 4 hours (72.97% vs. 81.79%), and IV-fluid infusion rate (0.00% vs. 18.85%). In comparing QI adherence rates by educational period subsets, two-set IV line showed signifi cant improvement after 7 months of education, and admission to ICU within 4 hours after 4 months of education. However, most QIs associated with severe sepsis (except serum lactate and antibiotic given in 1 hour) showed signifi cant improvement after 3 months of education. We concluded that there is much room to improve QI adherence rates in patients with 4S status, using educational initiatives.