Implication of the sepsis treatment protocol in Uttaradit Hospital for improving mortality rate
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2010-04-08
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Thai Journal of Tuberculosis Chest Diseases and Critical Care
Abstract
Background: The high mortality rate of septic patients in Uttaradit Hospital was due to the delay in diagnosis and improper management in the first six hours. The integration of sepsis treatment protocol into clinical practice might be useful tool for rapid diagnosis and treatment. Early attack to source of infection and effective supportive treatment may lead to normal organ system function and also reduce the complications, mortality rate and cost of treatment. Objective: To assess mortality rate before and after implementation of sepsis treatment protocol in Uttaradit Hospital. Method: This prospective study were conducted in post-protocol septic patients during August 2007 to January 2008 compared with retrospective medical reviews in pre-protocol septic patients during February to July 2007. Result: There were 448 septic patients included in the study. Four patients were excluded because of failure to fulfil the diagnostic criteria. The mean age of both groups were 62 years old. Mean APACHE II score were 22.57 VS 23.1. After septic protocol implementation, the mortality rate was significantly reduced from 67% to 52% (p \< 0.001). The inadequate fluid resuscitation, delayed starting time of initial antibiotic treatment and organ failure were associated with increasing mortality rate (p \< 0.001) in both groups. Rate of ICU transferring was increased from 18% to 43% (p \< 0.001) as well as rate of initial antibiotic receiving in three hours from 49% to 63% (p=0.02). Furthermore, the length of hospital stay tended to be shorten in contrast with prolonged ICU stay (p=0.99, 0.13 respectively). The pre-protocol cost of treatment was not increased compared to the post-protocol (p=0.15). Conclusion: The implementation of sepsis treatment protocol was benefit for mortality rate improvement but not for hospital cost-saving.
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Thai Journal of Tuberculosis Chest Diseases and Critical Care; Vol.29 No.3 July-September 2008; 241-251