2008 Ernest Amory Codman Award Program Hospital Category
Carolinas Medical Center Charlotte, North Carolina
Application of Early Goal-Directed Therapy
For the Treatment of Severe Sepsis and
Septic Shock in the Emergency Department
Over a three-year time frame, Carolinas Medical Center achieved a 30 percent relative reduction in in-hospital mortality of patients in the Emergency Department with suspected or confirmed sepsis. Using a modified version of the early goal-directed therapy (EGDT) protocol, the medical center's Code Sepsis Task Force created major change in the diagnosis and treatment of severe sepsis and septic shock. Sepsis patients were treated with a significantly greater crystalloid volume (3.3 L versus 6.3 L), higher frequency of vasopressor infusion (34 percent versus 73 percent), and greater packed red blood cell transfusion (3 percent versus 39 percent).
Achievements
- From 2004 to the intervention period (November 2005 to November 2007), absolute mortality for septic patients was reduced 8 percent and relative mortality was reduced 30 percent.
- Before the project was initiated, in-hospital mortality of sepsis patients was 21 of 79 patients (27 percent). During the second year of intervention (November 2006 to November 2007), mortality decreased to 13 of 75 patients (17 percent).
- Improved secondary outcomes for acute respiratory distress syndrome (6 percent reduction in mortality) and acute renal failure (7 percent reduction in mortality).