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A6002 - Frequency of Surviving Sepsis Campaign Bundle Compliance for Hospital-Acquired Sepsis
Author Block: S. Goodman1, S. Shah1, B. Varghese2, J. A. Greenberg3; 1Rush University Medical Center, Chicago, IL, United States, 2RUSH University Medical Center, CHICAGO, IL, United States, 3University of Chicago, Chicago, IL, United States.
Introduction: The Surviving Sepsis Campaign (SSC) recommends that clinicians perform specific interventions within three and six hours of sepsis identification. The survival benefit for patients who receive these interventions is better characterized for patients who present with sepsis to an emergency department than patients who develop sepsis on the hospital ward. The objective of this study was to determine the frequency of SSC bundle compliance among patients who were transferred from the hospital ward to the intensive care unit (ICU) for sepsis care.Methods:Adult inpatients at Rush University Medical Center from 2012-2013 were screened for sepsis using a validated ICD-9 search strategy. The medical records of patients who were transferred from the hospital ward to ICU and died during the hospitalization were reviewed. Patients were excluded if they were transferred from the hospital ward to ICU after cardiac arrest or for a reason other than sepsis management. The earliest times that blood cultures were drawn, antibiotics were administered, lactate was measured, and intravenous fluid was given within 24 hours of ICU admission was determined. Initial suspicion for sepsis was defined the first time that either blood cultures were drawn or antibiotics were administered.Results:Of the 144 patients identified by billing codes who were transferred from the hospital ward to ICU and died during the hospitalization, 48 (33%) were transferred to the ICU for sepsis management. There were 14 patients (29%) who received antibiotics within three hours of blood cultures. There were 14 patients (29%) who had lactate measured within three hours of sepsis identification. There were 12 patients (25%) who had hypotension or elevated lactate within three hours of sepsis identification, of whom 8 (67%) received the recommended intravenous fluid bolus. On average, patients received 50% (SD 25%) of all recommended interventions. There were 7 patients (15%) who received all of the recommended interventions. On average, sepsis was suspected 6 hours (SD 10 hours) prior to ICU admission. Patients who were admitted to the ICU within 6 hours of sepsis identification received a greater percentage of the recommended interventions than patients who were admitted to the ICU greater than 6 hours of sepsis identification (60% vs. 40%, p=0.005).Conclusions:Most patients who were transferred from the hospital ward to the ICU for sepsis management did not receive all of the recommended early interventions. A shorter time from sepsis identification to ICU admission was associated with greater bundle compliance.