 | Background Evidence suggests that early, timely and aggressive resuscitation for patients with septic shock can have significant impact on both morbidity and mortality. However, even with the widespread awareness of the Surviving Sepsis Campaign (SSC) guidelines, adherence varies widely. ProtocolWatch (PW) is a proprietary rules-based engine, designed by Philips Healthcare (Andover, MA) and available in IntelliVue bedside patient monitors. |
The first application, ProtocolWatch Sepsis (PWS), is designed to support compliance with SSC guidelines. PW monitors the patients for the signs and symptoms of sepsis, and when patients meet the physiologic criteria as outlined by the SSC, a series of prompts are displayed on the monitoring screen to help guide clinicians through the evidencebased recommendations for resuscitation and management that have been endorsed by the SSC.
Purpose
The purpose of this research was to measure the impact that using PWS had to adherence to the SSC guidelines.
Methods
This non-probability, convenience sample consisted of critically ill adult patients (at least 18 years
of age) admitted to two adult Intensive Care Units who were admitted with or developed
sepsis during their ICU stay, including sepsis as an admission diagnosis. Post-surgical cardiac
patients were excluded from the study. The final sample included 2 groups of septic patients, who
were treated according to SSC guidelines. 65 patients (Group 1) were managed using a paperbased protocol , and 70 patients (Group 2) were managed using the PWS application in the Philips bedside monitor. Variables collected included all of the variables that are part of the SSC database.
Results
Completion of resuscitation bundle significantly increased from 57.6% to 68% (p=.003). (Table 1)
Time to antibiotic administration was significantly reduced from 181.9 minutes to 112.3 minutes (p=0.02), representing more than a one hour
improvement. (Table 1)
Conclusions
These results provide initial support that PWS, a semi-automated electronic version of the SSC guidelines, can increase compliance with SSC guidelines. Automatic physiologic criteria screening at the bedside monitor may also shorten the recognition time of sepsis, thus speeding up the initiation of sepsis treatment. Development of tools such as Protocol Watch will likely be an important adjunct to sepsis identification and treatment in the future.
References
1. Using clinical decision support to improve the care of patients with sepsis. Critical Care Medicine. 2008, 36(12); (Suppl): A170.
2. Kumar A, Roberts D, Wood KE et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic
shock. Critical Care Medicine. 2006, 34 (6): 1589-96.
3. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008 [published
correction appears in Critical Care Medicine 2008, 36:1394-1396]. Critical Care Medicine. 2008, 36:296-327.