Emergency department, severe sepsis


Severe sepsis kills an estimated 1,400 people worldwide every day. This often fatal infectious process accounts for an estimated 215,000 deaths in the United States (US) annually. The main goal of this project was to evaluate the impact of the Emergency Department Severe Sepsis Alert and Practice Protocol (EDSSAPP) post implementation, on time to first antibiotic administration, length of stay, and mortality in patients admitted via the ORMC ED with severe sepsis. This study evaluated the time to first antibiotic administration, total ED and hospital length of stay (LOS) and mortality of severe sepsis patients either with a severe sepsis alert (SSA) activated or no alert activated that were admitted to the hospital through the ED. A retrospective review of the electronic medical record (EMR) was conducted to gather the required data across three time cohorts: base line/time zero (T0), six months prior to the implementation of EDSSAPP; Time one (T1) the first six months following initial EDSSAPP implementation; and Time two (T2), six months following reinstatement of the corporate sepsis committee. The most significant finding of this study was the increased number of Severe Sepsis Alerts activated in time cohort T2 (n=113) compared to T1 (n=19). Another important finding was the decreased mortality in T2 (16.4%) compared to T0 (22.7%) and T1 (33%). Overall, the number of ED patients with severe sepsis who received antibiotics within the EDSSAPP required 60 minutes did not consistently improve across the three time cohorts, T0 (81.8%), T1 (71.7%) and T2 (80.6%). The hospital LOS of stay was increased by almost 1.5 days between those patients with a severe sepsis alert activated in T1 (9.00 days) compared to time T2 (10.48 days). There was no significant decrease in the ED LOS across time cohorts and between groups of patients who had a SSA activated versus no alert activated. However, there was a 1 hour and 28 minute decrease in ED LOS in patients who had a severe sepsis alert activated in T1 compared to T0. In addition, there was a 1 hour and 52 minutes decrease in ED LOS between patients who had a SSA activated compared to those who had no alert activated in T2. While EDSSAPP data does not demonstrate the statistically significant results that was expected, the challenges related to adherence by providers to EDSSAPP is as it is seen in the literature. Increased awareness via consistent communication of on-going audit results to ED personnel will heighten their awareness for severe sepsis and EDSSAPP. Improved collaborative efforts with the interdisciplinary team are needed to refocus everyone's efforts to increase early recognition that is followed by appropriate treatment interventions and documentation is essential. Lastly, the development of a formal process to follow up with individual providers as close to real time as possible following a SSA that includes accountability for care provided and related documentation would also contribute to both awareness and adherence.


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Graduation Date





Andrews, Diane


Doctor of Nursing Practice (D.N.P.)


College of Nursing



Degree Program

Nursing Practice








Release Date

May 2020

Length of Campus-only Access

5 years

Access Status

Doctoral Dissertation (Open Access)

Included in

Nursing Commons