Implementation of a bundle of actions to improve adherence to the Surviving Sepsis Campaign guidelines at the ED

José M De Miguel-Yanes, Javier Muñoz-González, Juan A Andueza-Lillo, Berta Moyano-Villaseca, Víctor J González-Ramallo, Ana Bustamante-Fermosel
American Journal of Emergency Medicine 2009, 27 (6): 668-74

PURPOSES: We had previously demonstrated surviving sepsis campaign guidelines had not had enough impact at our Emergency Department.

BASIC PROCEDURES: Actions directed to increase the qualification of our staff and residents, to facilitate guidelines divulgation and to improve spatial conditions by creating a High Dependency Unit were implemented as a bundle. The impact of these actions on the achievement of early objectives of the campaign and on mortality was analyzed.

MAIN FINDINGS: Following campaign guidelines was more frequent after the implementation of these actions, as shown by less restrictive fluids administration for more severe cases (P = .001), earlier administration of antibiotics (P = .001) and lactate determination rate (46% vs. 12%). In-hospital mortality difference did not reach statistical difference. Physicians were able to identify high-risk patients on clinical grounds.

PRINCIPAL CONCLUSIONS: The bundle of actions has had a moderate beneficial effect on our Emergency Department. High Dependency Units are useful for managing patients not fulfilling criteria for Intensive Care Unit admission.

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