Implementation of a bundle of actions to improve adherence to the Surviving Sepsis Campaign guidelines at the ED

Purposes: We had previously demonstrated surviving sepsis campaign guidelines had not had enough impact at our Emergency Department. Basic Procedures: Actions directed to increase the qualification of our staff and residents, to facilitate guidelines divulgation and to improve spatial conditions by creating a High Dependency Unit were implemented as a bundle. The impact of these actions on the achievement of early objectives of the campaign and on mortality was analyzed. Main Findings: Following campaign guidelines was more frequent after the implementation of these actions, as shown by less restrictive fluids administration for more severe cases (P = .001), earlier administration of antibiotics (P = .001) and lactate determination rate (46% vs. 12%). In-hospital mortality difference did not reach statistical difference. Physicians were able to identify high-risk patients on clinical grounds. Principal Conclusions: The bundle of actions has had a moderate beneficial effect on our Emergency Department. High Dependency Units are useful for managing patients not fulfilling criteria for Intensive Care Unit admission. (C) 2009 Elsevier Inc. All rights reserved.