Mandated Emergency Care for Sepsis Proves Effective

A new study reveals that rapid completion of a mandated three-hour bundle of sepsis care protocol (which includes blood cultures, broad-spectrum antibiotic agents, and lactate measurement) is associated with lower in-hospital mortality.

Researchers at the University of Pittsburgh School of Medicine (Pitt; PA, USA), Brown University (Providence, RI, USA), and other institutions studied data on 49,331 patients admitted to 149 hospitals in New York State from April 1, 2014, to June 30, 2016. The patients followed a sepsis protocol initiated within six hours after arrival in the emergency department (ED) and had all items in a sepsis 3-hour bundle of care completed within 12 hours. The researchers assessed the associations between the time until completion of the 3-hour bundle and risk-adjusted mortality.

The results revealed that 82.5% of the patients had the 3-hour bundle completed on time. Median time to completion of the 3-hour bundle was 1.30 hours, the median time to the administration of antibiotics was 0.95 hours, and the median time to completion of the fluid bolus was 2.56 hours. Among patients who had the 3-hour bundle completed within 12 hours, higher risk-adjusted in-hospital mortality was associated with longer time to completion, longer time to the administration of antibiotics, but not with the completion of a bolus of intravenous fluids. The study was published on May 21, 2017, in NEJM.

“There is considerable controversy about how rapidly sepsis must be treated,” said lead author Christopher Seymour, MD, MSc, of the department of critical care medicine and emergency medicine at Pitt. “Some question the benefit of rapid treatment with protocols, saying they can have unintended side effects and be a distraction in busy emergency departments. After reviewing the data, we can finally say that faster is better when it comes to sepsis care.”

In 2013, following the widely publicized death of 12-year old Rory Staunton from undiagnosed sepsis, New York began issued protocols for the early identification and treatment of sepsis. Known as Rory's Regulations, they require hospitals to follow protocols for early identification and treatment of sepsis, and submit data on compliance and outcomes. Hospitals can tailor how they implement the protocols, but must include a blood culture to test for infection, measurement of blood lactate, and administration of antibiotics within three hours of diagnosis, collectively known as the three-hour bundle.

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University of Pittsburgh School of Medicine
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