Outcomes After Implementing Sepsis Clinical Practice Guidelines in the Internal Medicine Department of Phraphutthabat Hospital
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Abstract
Background: The implementation of clinical practice guidelines (CPG) for the treatment of sepsis plays can reduce patient mortality. Currently, updated guidelines based on the Surviving Sepsis Campaign 2021, which have demonstrated improved efficacy, have been adapted for use at Phraphutthabat Hospital.
Objective: To evaluate the outcomes of implementing an updated CPG based on the Surviving Sepsis Campaign, structured as a standing treatment order for the management of sepsis patients.
Materials and Methods: This was a retrospective analytical study of sepsis patients treated in the Department of Internal Medicine at Phraphutthabat Hospital. Patients were divided into two groups: pre-implementation (January–October 31, 2023) and post-implementation (November 2023 – August 2024) of the revised CPG. Data collected included patient demographics, antibiotic administration, fluid volume received, serum lactate levels, fluid reassessment, length of hospital stay, and mortality. Statistical analyses included Fisher’s exact test, t-test, and Mann-Whitney U test for group comparisons.
Results: A total of 304 patients were included, with 152 patients in each group. There were 73 cases (48.0%) and 71 cases (46.7%) of septic shock in the pre- and post-implementation groups, respectively. The 30-day mortality rate in the CPG group decreased from 36.2% to 24.3% (p = 0.025) among sepsis patients, and from 54.8% to 38.0% (p = 0.044) among patients with septic shock. Among the 292 patients who were hospitalized for no more than 30 days, the median length of stay decreased from 8 days [IQR 5,12] to 7 days [IQR 4,11] (p = 0.011). The most common infection site was the urinary tract, and the most frequently identified pathogen was Escherichia coli. After implementing the updated CPG, the percentage of patients who received 1,500 mL of fluids within the three hours, underwent fluid reassessment, and had serum lactate levels measured significantly increased. However, the percentage of patients who received antibiotics within one hour did not differ significantly.
Conclusion: The updated sepsis CPG implemented at Phraphutthabat Hospital effectively reduced 30 day mortality. The percentage of patients who received 1,500 mL of fluids within the three hours, underwent fluid reassessment, and had serum lactate levels measured increased.
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บทความที่ส่งมาลงพิมพ์ต้องไม่เคยพิมพ์หรือกำลังได้รับการพิจารณาตีพิมพ์ในวารสารอื่น เนื้อหาในบทความต้องเป็นผลงานของผู้นิพนธ์เอง ไม่ได้ลอกเลียนหรือตัดทอนจากบทความอื่น โดยไม่ได้รับอนุญาตหรือไม่ได้อ้างอิงอย่างเหมาะสม การแก้ไขหรือให้ข้อมูลเพิ่มเติมแก่กองบรรณาธิการ จะต้องเสร็จสิ้นเป็นที่เรียบร้อยก่อนจะได้รับพิจารณาตีพิมพ์ และบทความที่ตีพิมพ์แล้วเป็นสมบัติ ของลำปางเวชสาร
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