Introduction: Sepsis is common in ICU patients and despite a mortality benefit associated with early protocolized care, adherence to management guidelines remains inconsistent. Methods: In this randomized trial, patients admitted to the MICU and SICU with sepsis were randomized to usual care vs treatment with a novel electronic sepsis management tool. The sepsis tool, available via the EMR throughout the ICU admission, presented a divided display with one half graphing trend and goal for HR, MAP, CVP, Hgb, and lactate and the other half offering sepsis assessment and management tabs in a work-flow modeled on the Surviving Sepsis Campaign 2008 guidelines with one-click order entry for labs, cultures, imaging, antibiotics, and goal-directed resuscitation. Results: Of 346 patients, 164 were randomized to control and 182 to sepsis tool with no difference in age, gender, race, presence of sepsis on admission, or source of sepsis. Intention-to-treat analysis showed no difference in time to blood cultures ordered (2.54h vs. 3.82h, p=0.451), antibiotics administered (3.82h vs. 3.55h, p=0.585), CVP measured (6.00h vs. 5.61h, p=0.340), vasopressor ordered (4.84h vs. 5.25h, p=0.284), lactate measured (2.12h vs. 1.85h, p=0.472). There was no difference in percentage of patients who in the first 6h had blood cultures obtained, antibiotics administered, CVP measured, vasopressors ordered, or lactated measured. Per-protocol analysis of 44 patients on whom the tool was utilized to enter orders versus the remaining 302 patients showed no differences in age, gender, race, route of admission, sepsis at admission, or source of sepsis. There was no difference in the rate of or time to blood cultures, antibiotics, vasopressors, lactate measurement. Patients who had orders placed trended toward quicker CVP measurement (4.97h vs. 5.92h, p=0.123), higher rate of CVP in the first 6 hours (39.5% vs. 26.7%, p=0.081), with higher rate of CVP>=8 (34.1% vs. 19.9%, p=0.032). Conclusions: This study establishes the feasibility of instituting an integrated, electronic tool for sepsis management. Assessment of the effect on procedural and clinical outcomes is limited by low utilization of the tool.
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