Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED

Abstract Background Early identification of sepsis in the emergency department (ED), followed by adequate fluid hydration and appropriate antibiotics, improves patient outcomes. Objectives We sought to measure the impact of a sepsis workup and treatment protocol (SWAT) that included an electronic he...

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Bibliographic Details
Published in:The American journal of emergency medicine 2016-01, Vol.34 (1), p.1-9
Main Authors: Hayden, Geoffrey E., MD, Tuuri, Rachel E., MD, Scott, Rachel, MD, Losek, Joseph D., MD, Blackshaw, Aaron M, Schoenling, Andrew J, Nietert, Paul J., PhD, Hall, Greg A., MD
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - therapeutic use
Antibiotics
Bacterial infections
Clinical outcomes
Clinical Protocols
Confidence intervals
Electronic Health Records
Emergency
Emergency medical care
Emergency Service, Hospital
Female
Fluid Therapy
Fluids
Heart rate
Hospitals
Humans
Infections
Male
Medical records
Middle Aged
Mortality
Paging systems
Patients
Retrospective Studies
Sepsis
Sepsis - diagnosis
Sepsis - mortality
Sepsis - therapy
Time Factors
Triage
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Summary:Abstract Background Early identification of sepsis in the emergency department (ED), followed by adequate fluid hydration and appropriate antibiotics, improves patient outcomes. Objectives We sought to measure the impact of a sepsis workup and treatment protocol (SWAT) that included an electronic health record (EHR)–based triage sepsis alert, direct communication, mobilization of resources, and standardized order sets. Methods We conducted a retrospective, quasiexperimental study of adult ED patients admitted with suspected sepsis, severe sepsis, or septic shock. We defined a preimplementation (pre-SWAT) group and a postimplementation (post-SWAT) group and further broke these down into SWAT A (septic shock) and SWAT B (sepsis with normal systolic blood pressure). We performed extensive data comparisons in the pre-SWAT and post-SWAT groups, including demographics, systemic inflammatory response syndrome criteria, time to intravenous fluids bolus, time to antibiotics, length-of-stay times, and mortality rates. Results There were 108 patients in the pre-SWAT group and 130 patients in the post-SWAT group. The mean time to bolus was 31 minutes less in the postimplementation group, 51 vs 82 minutes (95% confidence interval, 15-46; P value < .01). The mean time to antibiotics was 59 minutes less in the postimplementation group, 81 vs 139 minutes (95% confidence interval, 44-74; P value < .01). Segmented regression modeling did not identify secular trends in these outcomes. There was no significant difference in mortality rates. Conclusions An EHR-based triage sepsis alert and SWAT protocol led to a significant reduction in the time to intravenous fluids and time to antibiotics in ED patients admitted with suspected sepsis, severe sepsis, and septic shock.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2015.08.039