Before–after study of a standardized hospital order set for the management of septic shock*

TLDR

The study aimed to evaluate the impact of a standardized hospital order set on septic shock management in the emergency department. A prospective before‑after design enrolled 120 consecutive septic shock patients (60 before and 60 after implementation) at a 1,200‑bed academic ED. Implementation of the order set led to more aggressive fluid resuscitation, higher rates of appropriate initial antibiotics, reduced vasopressor use at ICU transfer, shorter hospital stays, and a lower 28‑day mortality, supporting routine use of standardized order sets for septic shock.

Abstract

To evaluate a standardized hospital order set for the management of septic shock in the emergency department.Before-after study design with prospective consecutive data collection.Emergency department of a 1,200-bed academic medical center.A total of 120 patients with septic shock.Implementation of a standardized hospital order set for the management of septic shock.A total of 120 consecutive patients with septic shock were identified. Sixty patients (50.0%) were managed before the implementation of the standardized order set, constituting the before group, and 60 (50.0%) were evaluated after the implementation of the standardized order set, making up the after group. Demographic variables and severity of illness measured by the Acute Physiology and Chronic Health Evaluation II were similar for both groups. Patients in the after group received statistically more intravenous fluids while in the emergency department (2825 +/- 1624 mL vs. 3789 +/- 1730 mL, p = .002), were more likely to receive intravenous fluids of >20 mL/kg body weight before vasopressor administration (58.3% vs. 88.3%, p < .001), and were more likely to be treated with an appropriate initial antimicrobial regimen (71.7% vs. 86.7%, p = .043) compared with patients in the before group. Patients in the after group were less likely to require vasopressor administration at the time of transfer to the intensive care unit (100.0% vs. 71.7%, p < .001), had a shorter hospital length of stay (12.1 +/- 9.2 days vs. 8.9 +/- 7.2 days, p = .038), and a lower risk for 28-day mortality (48.3% vs. 30.0%, p = .040).Our study found that the implementation of a standardized order set for the management of septic shock in the emergency department was associated with statistically more rigorous fluid resuscitation of patients, greater administration of appropriate initial antibiotic treatment, and a lower 28-day mortality. These data suggest that the use of standardized order sets for the management of septic shock should be routinely employed.