Mortality Rate Among Patients with Septic Shock after Implementation of 6-Hour Sepsis Protocol in the Emergency Department of Thammasat University Hospital
Yajai Apibunyopas MD*
Affiliation : Thammasat University Hospital, Pathumthani, Thailand
Background : Septic shock is a major healthcare problem effecting people worldwide with high mortality rate. Administering
early and appropriate interventions can help improve the outcome. The 6-hour bundle, launched by the Surviving Sepsis
Campaign committee was part of efforts to incorporate evidence-based guideline to clinical practice. There were many
reports on outcome improvement of septic shock patients after implementation of the 6-hour bundle at the emergency
department.
Objective : To compare mortality rate of septic shock patients before and after implementing the 6-hour sepsis protocol at the
emergency department of Thammasat University Hospital.
Materials and Methods : Study was conducted at the emergency department of Thammasat University Hospital. This is an
interrupted time, before and after study, comparing between the prospective cohort period after (Oct 2012 to Nov 2013) and
the historical control period before (Feb 2011 to July 2012) implementation of 6-hour sepsis protocol. Primary outcome was
hospital mortality of septic shock patients. Secondary outcomes included length of hospital stay and predictive factors for
mortality of septic shock patients.
Results : There were 80 patients included in the pre-intervention group and 75 patients in the post-intervention group. There
was significant improvement in management of septic shock patients. Total fluid given in 2 hours in the post-intervention
group was significantly higher [2,000 (500-3,000) vs. 1,600 (100-3,600); p = 0.038)] when compared with the pre-intervention
group. The entire resuscitation bundles compliance rate was significantly increased in the post-intervention group (37.3% vs.
0%; p<0.001). Regarding each intervention in the 6-hour bundle, included serum lactate measurement, giving fluid bolus
>500 ml and maintaining MAP >65 mmHg, were all significantly increased in rate of compliance (96.0% vs. 2.5%; p<0.001,
100.0% vs. 92.3%; p = 0.029, 100.0% vs. 88.8%; p = 0.003, respectively). Hospital mortality was reduced significantly after
implementation of the 6-hour sepsis protocol (18.7% vs. 40.0%; p = 0.005).
Conclusion : Septic shock mortality was decreased after implementation of the 6-hour sepsis protocol at the emergency
department of Thammasat University Hospital.
Keywords : 6-hour bundle, Resuscitation bundle, Septic shock, Emergency department, Sepsis protocol
