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Computer Protocol Facilitates Evidence-Based Care of Sepsis in the Surgical Intensive Care Unit

McKinley, Bruce A. PhD; Moore, Laura J. MD; Sucher, Joseph F. MD; Todd, S. Rob MD; Turner, Krista L. MD; Valdivia, Alicia RN; Sailors, R. Matthew BE; Moore, Frederick A. MD

Journal of Trauma and Acute Care Surgery: May 2011 - Volume 70 - Issue 5 - p 1153-1167
doi: 10.1097/TA.0b013e31821598e9
Original Article

Background: Care of sepsis has been the focus of intense research and guideline development for more than two decades. With ongoing success of computer protocol (CP) technology and with publication of Surviving Sepsis Campaign (SSC) guidelines, we undertook protocol development for management of sepsis of surgical intensive care unit patients in mid-2006.

Methods: A sepsis protocol was developed and implemented in The Methodist Hospital (TMH) (Houston, TX) surgical intensive care unit (27 beds) together with a sepsis research database. We compare paper-protocol (PP) (2008) and CP (2009) performance and results of the SSC guideline performance improvement initiative (2005–2008). TMH surgical intensive care unit sepsis protocol was developed to implement best evidence and to standardize decision making among surgical intensivists, nurse practitioners, and resident physicians.

Results: The 2008 and 2009 sepsis protocol cohorts had very similar number of patients, age, % male gender, Acute Physiology and Chronic Health Evaluation scoring system II, and Sequential Organ Failure Assessment scores. The 2008 PP patients had greater baseline lactate concentration consistent with greater mortality rate. Antibiotic agents were administered to 2009 CP cohort patients sooner than 2008 PP cohort patients. Both cohorts received similar volume of intravenous fluid boluses. Comparing 6-hour resuscitation bundle compliance, the 2009 CP cohort was substantially greater than SSC eighth quarter and 2008 PP cohorts (79% vs. 31% vs. 29%), and mortality rate was much less when using the CP (14% vs. 31% vs. 24%).

Conclusions: Our comprehensive sepsis protocol has enabled rapid and consistent implementation of evidence-based care, and, implemented as a bedside CP, contributed to decreased mortality rate for management of surgical sepsis.

From the Department of Surgery, The Methodist Hospital Research Institute, Houston, Texas; Weill Cornell Medical College, New York, New York.

Submitted for publication September 17, 2010.

Accepted for publication February 14, 2011.

Supported by the Methodist Hospital Research Institute.

Presented at the 69th Annual Meeting of the American Association for the Surgery of Trauma, September 22–25, 2010, Boston, Massachusetts.

Address for reprints: Bruce A. McKinley, PhD, Department of Surgery, University of Florida, Gainesville, FL 32610.

© 2011 Lippincott Williams & Wilkins, Inc.