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CS146
Implementation of Early Goal-Directed Therapy for Sepsis at a Community Hospital through a Multidisciplinary Approach
By M. Atkinson, P. Cerone, S. Chesney, J. Cowen, T. Hashemi, T. Hodgman, A. Joffe, N. Lidsky, D. Nixon, C. Ruiz, D. Ryzner; Northwest Community Healthcare, Arlington Heights, IL
For further information, please contact: matkinso@nch.org
Purpose: Early Goal-Directed Therapy (EGDT) for patients presenting with septic shock is strongly supported in the Surviving Sepsis Campaign guidelines and by the Institute for Heathcare Improvement. The sentinel study by Rivers et al. was conducted in an optimized environment, which included a specialized mini-ICU located within the ED. This has resulted in much concern and debate in the Critical Care community regarding the ability to overcome the impediments that prevent timely implementation of EGDT in a community hospital setting. Therefore, we developed a protocolized approach to early identification and treatment of patients with septic shock who presented to the ED. We also sought to identify any process issues that could impact upon timely implementation of EGDT and the other components of the "sepsis bundle".
Description: The EGDT and "sepsis bundle" protocols were developed by the Critical Care Multidisciplinary Evidence-Based Practice group. A multidisciplinary sepsis team was then developed to educate the ED and ICU staff through lectures, in-services, and reinforcement at departmental meetings. Staff nurses were recruited as "Change Champions" to promote and encourage compliance with the evidence-based guidelines. We also designed sepsis-specific doctor's order sets and an ICU flow sheet to both optimize patient care and data collection. A computerized database tool was developed to capture traditional outcome measures as well as numerous process variables inherent in the achievement of EGDT.
Evaluation/Outcomes: The sepsis team approach reduced the time to initiation of EGDT. It is possible to effectively implement, in a timely manner, EGDT for patients with septic shock in a community hospital setting. This can be accomplished through re-organization of existing resources and formation of a dedicated sepsis team. Data collection and review of process issues is an essential component of this ongoing effort.
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