Initial Review of an Early Goal Directed Therapy for Septic Shock at Grant Medical Center: Is There a Reduction in Mortality and Morbidity?

Background:

It is estimated that severe sepsis /septic shock is one of the most common causes of mortality in the ICU and a large percentage of those cases are identified in the emergency room. Rivers, et al., in 2001, demonstrated that the early directed therapy for severe sepsis/septic shock resulted in significant benefits in patients illustrated by reduction in mortality and morbidity. It was hypothesized that a Sepsis Shock Alert protocol (SSAP) utilizing family medicine residents as first responders of this multidisciplinary team to initiate sepsis orders would allow timely placement of central venous catheter and arterial lines allowing early goal‐oriented therapy for septic shock, therefore reducing morbidity and mortality for these patients at Grant Medical Center

Methods:

Using a retrospective chart review, the effect of the initiation of the SSAP on in‐hospital mortality and length of hospital stay (LOS) was investigated by analyzing data for patients that met criteria for a septic shock alert for 7 months prior to and 7 months after the implementation of the alert system. Inclusion criteria included patients who had ICD‐9 code for Sepsis Alert criteria, admitted through the Emergency Department, SIRS (systemic inflammatory response syndrome) positive, evidence of infection, SBP (systolic blood pressure) <90 mm Hg, and blood lactate concentration >4 mmol/L. Exclusion criteria were patient transferred from outside facilities and age <18 years old.

Results:

There was a statistically significant difference in LOS between the pre vs. post alert groups. LOS mean for pre‐alert group was 14.1 day, vs. post‐alert group at 7.7 days. (T‐test; t= 3.5, DF 146, p<.001). There was no statistical significance difference between the pre and post alert groups for in‐hospital mortality (pre‐alert group (22.3%) vs. post‐alert group (14.8%) Chi‐square = 1.2, df =1, p= 267)

Conclusions:

The institution of a SSAP at GMC, through a multidisciplinary team involving FP residents, demonstrated clinically significant improvement of in‐patient mortality and did statistically significant reduction in the length of hospital stay. Decreased in length of stay, may aid in decreasing healthcare cost, adverse hospital related events, patient stress, disability, etc. Future investigation into standardizing for other institutions with healthcare synstem, opening up the protocol to the wards versus E.R., and looking at affects of the protocol over a longer time period may be beneficial to patient outcomes