(1429) Sepsis Bundle Compliance Before and After Implementation of a Protocolized Sepsis Program

Introduction: Sepsis, a life-threatening medical emergency, carries a mortality risk up to 80% in the absence of prompt medical attention. Protocolized approaches to sepsis management, or “sepsis bundles,” have been increasingly adopted by medical institutions to improve clinical outcomes and compliance rates. This study evaluated the effects of a protocolized sepsis algorithm to improve Centers for Medicare & Medicaid Services hour-3 bundle compliance.

Methods: This retrospective, single-center study included patients age ≥ 18 years admitted for severe sepsis or septic shock who received at least one dose of antibiotics within 24 hours of admission, either pre-Code Sepsis (PC) between 3/15/22 and 6/15/22, or after Code Sepsis implementation (AC) between 3/15/23 and 6/15/23. Patients were excluded if sepsis treatment began at an outside hospital. The Code Sepsis program consists of a team-based algorithm of sepsis bundle components including fluids, antibiotics, laboratory studies and clinical assessment to enhance timely completion of bundle requirements. The primary outcome evaluated hour-3 bundle compliance. Secondary outcomes included hour-1 and hour-6 bundle compliance. Data were analyzed using SPSS v.29.

Results: Of 730 evaluated, 118 severe sepsis or septic shock patients were included (59 PC vs 59 AC). Baseline characteristics were similar, with a mean age of 63±18 years, 45% male, and 42% with septic shock overall. A trend to significance was seen in the AC group for hour-3 bundle compliance (25% PC vs 41% AC, p=0.07). Appropriate initial fluid bolus was higher in the AC group (46% PC vs 83% AC, p< 0.001). Compliance for hour-1 (9% PC vs 17% AC, p=0.16) and hour-6 (41% PC vs 53% AC, p=0.08) bundles were similar. Hospital length of stay (LOS) was shorter in the AC group (10±8 days PC vs 7±7 AC, p=0.03) but not different for the emergency center (11±40 hours PC vs 12±31 AC, p=0.77) or the intensive care unit (6±6 days PC vs 7±10 AC, p=0.61) LOS. Mortality rates were similar (20% PC vs 10% AC, p=0.13).

Conclusions: Utilization of a protocolized Code Sepsis program was associated with a trend toward improved bundle compliance, significantly improved appropriate fluid bolus rates, and reduced hospital LOS. Further exploration is warranted to enhance bundle compliance.