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Effects on management and outcome of severe sepsis and septic shock patients admitted to the intensive care unit after implementation of a sepsis program: a pilot study

Massimo Girardis1*, Laura Rinaldi1, Lara Donno1, Marco Marietta2, Mauro Codeluppi3, Patrizia Marchegiano4, Claudia Venturelli5 and the 'Sopravvivere alla Sepsi 'group of the Modena-University Hospital

Author Affiliations

1 Department of Anaesthesiology and Intensive Care, University of Modena and Reggio Emilia and University Hospital of Modena; L.go del Pozzo, Modena, 41100, ITALY

2 Department of Haematology, University Hospital of Modena; L.go del Pozzo, Modena, 41100, ITALY

3 Department of Infectious Diseases, University Hospital of Modena; L.go del Pozzo, Modena, 41100, ITALY

4 Medical Direction, University Hospital of Modena; L.go del Pozzo, Modena, 41100, ITALY

5 Microbiology and Virology Unit, University Hospital of Modena; L.go del Pozzo, Modena, 41100, ITALY

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Critical Care 2009, 13:R143 doi:10.1186/cc8029

Published: 3 September 2009

Abstract

Introduction

The application in clinical practice of evidence-based guidelines for the management of patients with severe sepsis/septic shock is still poor in the emergency department, while little data are available for patients admitted to the intensive care unit (ICU). The aim of this study was to evaluate the effect of an in-hospital sepsis program on the adherence to evidence-based guidelines and outcome of patients with severe sepsis/septic shock admitted to the ICU.

Methods

This prospective observational cohort study included 67 patients with severe sepsis/septic shock admitted to a multidisciplinary ICU at a University Hospital from January 2005 to June 2007. Compliance to 5 resuscitation and 4 management sepsis interventions and in-hospital mortality were measured following an educational program on sepsis for physician and nurses of all hospital departments and hospital implementation of a specific protocol for recognition and management of patients with severe sepsis/septic shock, including an early consultation by a skilled 'sepsis team'.

Results

During the study period, the compliance to all 9 interventions increased from 8% to 35% of the patients (P < 0.01). The implementation of resuscitation and management interventions was associated with a lower risk of in-hospital mortality (23% vs 68% and 27% vs 68%, P < 0.01). In the latter 2 semesters, after activation of the 'sepsis team', in-hospital mortality of ICU septic shock patients decreased by about 40% compared with the previous period (32% vs 79%, P < 0.01).

Conclusions

In our experience, an in-hospital sepsis program, including education of health-care personnel and process-changes, improved the adherence to guidelines and the survival rate of patients with severe sepsis/septic shock admitted to the ICU.