Using a multidisciplinary acute sepsis initiative to teach early Goal-Directed therapy for sepsis-induced hypoperfusion states

Abstract

Study objectives: Resuscitation guided by an early goal-directed therapy (EGDT) protocol has been shown to improve mortality in severe sepsis and septic shock. Although recent consensus recommendations for acute sepsis management have incorporated these principles, EGDT is still not widely practiced in emergency medicine. Our primary goal is to determine whether a multidisciplinary education program (Cooper Acute Sepsis Initiative [ASI]) could improve understanding of EGDT principles, thereby facilitating protocol implementation in a university-based medical center. Secondarily, we hypothesized that perceptions of utility and feasibility of EGDT would be favorable after our education program. Methods: The Cooper ASI, a multidisciplinary education project using a lecture series and simulator models, was developed to educate emergency medicine and ICU health care providers about principles of EGDT, including early recognition of sepsis-induced hypoperfusion states and endpoints of resuscitation (including central venous pressure, mean arterial pressure, and central venous oximetry). To assess this training program, a pretest and posttest were administered to resident physicians. Knowledge base of EGDT principles, as well as resident physician perceptions of the utility and feasibility of EGDT, were assessed (10-point Likert scale, 1=very low, 10=very high). Results: After the ASI, resident physicians (n=19) demonstrated an improved knowledge of EGDT principles (pretest mean 68%, 95% confidence interval [CI] 61% to 85%; and posttest mean 99%, 95% CI 96% to 100%). Perceptions about utility of EGDT were very favorable (8.4 [95% CI 7.6 to 9.3] for utility in diagnosis; and 8.4 [95% CI 7.5 to 9.3] for utility in management, respectively). Perceptions about feasibility were more conservative (6.5 [95% CI 5.4 to 7.4] for technical difficulties; and 5.6 [95% CI 4.1 to 7.1] for resource consumption, respectively). After the ASI, EGDT was endorsed by emergency medicine and ICU administration at our institution and adopted as a hospital-wide protocol for sepsis. Conclusion: A multidisciplinary ASI improved resident physician understanding of EGDT principles. After the ASI, perceptions of the utility of EGDT in patient diagnosis and management were quite favorable. Perceptions of the feasibility of EGDT and resource consumption were lower, with junior residents trending to a more conservative view (results not significant). At our institution, EGDT has been well received. The multidisciplinary ASI facilitated EGDT implementation, which could potentially improve early recognition of hypoperfusion states, goal-directed hemodynamic management, and patient care.