Abstract
Background
The Surviving Sepsis Campaign implemented a 3-hour bundle including blood cultures,
lactate, intravenous fluids, and antibiotics to improve mortality in sepsis. Though
difficult to achieve, bundle compliance is associated with decreased hospital mortality.
We predict that the implementation of an Emergency Medical Services (EMS) sepsis screening
tool will improve 3-hour bundle compliance.
Objectives
To determine if pre-hospital sepsis screening improves 3-hour bundle compliance.
Methods
Prospective implementation of an EMS sepsis screening tool (June 2016–November 2016)
was compared to a historical control (August 2015–March 2016). The protocol was facilitated
via communication between nurses and EMS personnel. The primary outcome was 3-hour
bundle compliance. Secondary outcomes included time to individual bundle components.
Results
Of 135 patients screened, 20 were positive and included in the study, and subsequently
compared to 43 control patients. Baseline demographics were similar, except median
Sequential Organ Failure Assessment (SOFA) score was higher for the pre-EMS tool group
(5 [interquartile range (IQR) 2–8] vs. 2 [IQR 1–4], p < 0.01). Three-hour bundle compliance was significantly higher in the EMS tool group
(80% vs. 44.2%, p < 0.01). The pre-EMS tool group had lower median time to lactate (15 [IQR 0–35] vs.
46 min [IQR 34–57], p < 0.001), 30 mL/kg IV fluids (6.5 [IQR 0–38] vs. 46 min [IQR 27.5–72], p < 0.001),
and, although not significant, antibiotics (63.5 [IQR 44–92] vs. 72 min [IQR 59.5–112],
p = 0.26).
Conclusion
Implementation of an EMS sepsis screening tool resulted in improved 3-hour bundle
compliance compared to retrospective control.
Keywords
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Article Info
Publication History
Published online: October 20, 2018
Accepted:
October 18,
2018
Received in revised form:
October 17,
2018
Received:
July 1,
2018
Footnotes
☆This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
☆The results in this paper have been presented in abstract form at the Society for Academic Emergency Medicine (SAEM) annual meeting in Indianapolis, Indiana, May 15–May 18, 2018.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
