Implementation and outcomes of a severe sepsis protocol in an Australian tertiary hospital

OBJECTIVE: To evaluate the effect of implementation of a sepsis protocol. Design: Before and after cohort study. Setting: Level III ICU in a tertiary regional hospital, February - July, 2006 (before intervention) and 2007 (after). PARTICIPANTS: Adult patients who fulfilled criteria for severe sepsis or septic shock within 48 hours of ICU admission. INTERVENTION: Implementation of a locally modified sepsis protocol. Main outcome measures: Delivery of process of care components, and ICU and hospital mortality. Results: A total of 110 patients were included in the study: 44 in the pre-protocol group, and 66 in the post-protocol group. Demographic variables and severity of illness variables were similar in the two groups except for a lower incidence of respiratory sepsis in the post-protocol group. Post- protocol, there was a shorter time to initiation of appropriate antibiotics, and an increase in the use of vasopressors, deep vein thrombosis prophylaxis, and nutritional support, with no difference in ICU or hospital mortality. There was no difference in resuscitation endpoints at 6, 24, and 72 hours. CONCLUSIONS: Implementation of a sepsis protocol led to a change in the delivery of care with no reduction in mortality in patients with severe sepsis and septic shock admitted to a Level III ICU in a tertiary hospital. (author abstract)