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Hospital-wide impact of a standardized order set for the management of bacteremic severe sepsis*

Thiel, Steven W. MD; Asghar, Muhammad F. MD; Micek, Scott T. PharmD; Reichley, Richard M. RPh; Doherty, Joshua A. BS; Kollef, Marin H. MD

doi: 10.1097/CCM.0b013e318196206b
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Objective: To evaluate the hospital-wide impact of a standardized order set for the management of bacteremic severe sepsis on processes of medical care and patient outcomes.

Design: Retrospective, before and after study design.

Setting: Barnes-Jewish Hospital, a 1200-bed academic medical center.

Patients: Bacteremic patients with severe sepsis (200 from the 18-month before period and 200 from the 18-month after period).

Interventions: Hospital-wide implementation of a standardized order set for the management of bacteremic severe sepsis.

Measurements and Main Results: A total of 400 patients with bacteremia and severe sepsis were selected at random within the specified time periods. Patients in the after group received more intravenous fluids in the first 12 hours after onset of hypotension (1627 ± 1862 mL vs. 2054 ± 2237 mL; p = 0.04) and were more likely to receive appropriate initial antibiotic therapy (53.0% vs. 65.5%, p = 0.01). In-hospital mortality was statistically decreased in the after group (55.0% vs. 39.5%, p < 0.01), as was the hospital length of stay (28.7 ± 30.1 days vs. 22.4 ± 20.9 days; p = 0.02). Compared with the before group, the after group had reduced occurrence of renal failure (49.0% vs. 36.0%, p < 0.01), cardiovascular failure (70.5% vs. 57.0%, p < 0.01), and were less likely to require vasopressors after initial fluid resuscitation (68.5% vs. 52.5%, p < 0.01).

Conclusions: The implementation of a hospital-wide standardized order set for the management of bacteremic severe sepsis was associated with greater fluid administration, improved antibiotic therapy, decreased incidence of organ failure, and improved survival.

From the Pulmonary and Critical Care Division (SWT, MHK), Washington University School of Medicine; Department of Internal Medicine (MFA), St. Luke’s Hospital, St. Louis, MO; Department of Pharmacy (STM), Barnes-Jewish Hospital; and BJC Health Care (RMR, JAD), Center for Healthcare Quality and Effectiveness, St. Louis, MO.

Supported, in part, by the Barnes-Jewish Hospital Foundation.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: mkollef@im.wustl.edu

© 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins