Impact of Sepsis Intervention Protocol (SIP) on Adherence to Three-hour and Six-hour Bundles and Mortality Outcomes in the Emergency Department.

Abstract

Sepsis is a commonly encountered diagnosis affecting nearly 1.7 million adults in the USA annually. According to Center for Disease Control (CDC), over 270,000 Americans die of sepsis each year and 1 in 3 hospital mortalities is attributed to sepsis. The Surviving Sepsis Campaign (SSC) Guidelines for management of severe sepsis and septic shock published in 2004 provide key elements in the treatment of sepsis that are organized into two bundles of care, the "resuscitation" and "management" bundles, including interventions to be accomplished within specified timeframes. In this quality improvement study, we implemented a sepsis intervention protocol (SIP) intended to increase adherence to 3-hour and 6-hour bundles, and to examine the impact on mortality of patients presenting with severe sepsis and septic shock in our emergency department. We analyzed data from our emergency department as reported to the New York State Department of Health (NYSDOH) from 2017Q2 to 2018Q2 (April 2017 -June 2018), the period prior to implementation of SIP, compared to data from 2018Q3 to 2019Q2 (July 2018 to June 2019) after implementation of SIP. The implementation of SIP resulted in increased3-hour and 6-hour bundle adherence and showed a clinically significant reduction of the mean pre-intervention hospital percent mortality of 40.3% to a mean post-intervention hospital percent mortality of 28.7%. A t-test analysis of the pre and post intervention mean hospital percent mortality revealed a reduction in mortality outcomes that was also statistically significant (p <0.05). Our study demonstrates that a well-designed and implemented SIP can increase bundle adherence and is highly effective in reducing mortality among high-risk population.