Outcome after implementation of sepsis guideline in the emergency department of a university hospital in Hong Kong

Abstract

Introduction: Internationally, standard care of patients with severe sepsis consists of early detection, early antimicrobial therapy, and aggressive intravenous fluid therapy to maintain tissue oxygenation and perfusion. In this retrospective study, we aimed to examine the management of patients with severe sepsis in a local university hospital emergency department before and after the implementation of a sepsis management guideline. Method: We collected data on the management and outcome of patients during a three-month period before the implementation of a sepsis guideline (October-December 2009). We then collected similar data one year after the implementation (October-December 2010). Key sepsis management areas and inhospital mortality rates were compared, as were length of resuscitation, three-month mortality rate, hospital length of stay (LOS) and intensive care unit (ICU) LOS. Results: Data from 115 patients were collected in the pre-implementation group, while data on 102 patients were collected for the post-implementation group. There were more patients with hypoperfusion in the post-implementation cohort (25.2% vs. 40.2%, p=0.019). There was no difference in background characteristics, average lactate value, average MAP or number of hypotensive patients between the two groups. Significantly more antibiotics were given after the intervention (13.0% vs. 23.5%, p=0.045) and more patients had a lactate level measured (43.0% vs. 73.5%; p<0.001). There was a trend towards better survival for a subgroup of patients with hypoperfusion (48.0% vs. 29.2%, p=0.060). Conclusions: Implementation of a sepsis guideline leads to more antibiotics being given and more lactate measurement in the emergency department.