Feasibility of introduction and implementation of the Surviving Sepsis Campaign bundle in a Singapore emergency department.

OBJECTIVES: The Surviving Sepsis Campaign has been shown to improve the outcome of patients with severe sepsis or septic shock in Europe and North America. We aim to examine the impact of implementing the severe sepsis resuscitation bundle as part of standard care at the National University Hospital Emergency Department (ED) and assess its feasibility in Singapore.

MATERIALS AND METHODS: Adult patients presenting to the ED with severe sepsis and septic shock from 1 July 2008 to 31 December 2009 were included. Implementation of the bundle was divided into six quartiles: Baseline, Education and four Quality Improvement quartiles. The primary outcome of interest was bundle compliance. Other clinical outcomes include mortality and difference in treatment between the two groups.

RESULTS: One hundred and seventeen patients were included. The median age was 58 years and the median APACHE II score was 20. The overall in-hospital mortality was 26.5%. Compliance to all items of the bundle was 0, 10, 24, 24, 7 and 40%, respectively, over six quartiles. Patients who received the entire bundle had a crude mortality of 11.1%, which is 18.2% lower than those who received only some or none of the bundle components. Patients receiving the entire bundle tend to receive about 1 litre more intravenous fluids in the ED.

CONCLUSION: There was zero compliance to the severe sepsis resuscitation bundle at baseline. Quality improvement initiatives resulted in better compliance and outcome for patients, showing that such a protocol of management is feasible in a typical Singapore ED.