• Harman S Gill, Sage Lincoln, Jesse Tucker, Jeffrey Northey, Alyson M Esteves, and Todd D Morrell.
• Department of Medicine, Section of Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA. Harman.S.Gill@hitchcock.org.
• Intern Emerg Med. 2023 Nov 1; 18 (8): 236723762367-2376.

IntroductionCompliance with core sepsis measures in Emergency Departments (ED) remains low, with a limited number of prospective trials highlighting strategies for improvement.MethodsA prospective historically case-controlled observational analysis assessing the pre- and post -intervention impact of a sepsis tracking sheet (STS) and the involvement of ED pharmacists. PrimaryThe primary outcome was the improvement in compliance with core sepsis measures. SecondaryThe secondary outcome was to assess the frequency of respiratory interventions and mortality with pre-defined strata of fluid resuscitation (≤ 10, 10-20, 20-30, 30, ≥ 30 cc/kg of ideal body weight).Results194 patients were enrolled over a six -month period with a 9.3% all-cause mortality and a 10.3% rate of new respiratory interventions after fluid boluses. Post-STS implementation compliance of repeat lactate measurement was 88% (vs. 33% pre-STS), broad-spectrum antibiotic administration within 3 h of presentation improved to 96% (vs. 20% pre-STS), blood cultures were drawn on 98% of patients (vs. 9% pre-STS), and 30 cc/kg fluid boluses were administered to 39% of patients (vs. 25% pre-STS). Of the 18 deaths and 21 respiratory interventions, only two patients fell into both categories. Mortality was highest in those patients that received greater than 30 cc/kg of fluid resuscitation (50%). Respiratory interventions were greatest in the strata receiving 10-20 cc/kg of fluids (47.6%). Patients receiving the lowest fluid aliquots of < 10 cc/kg had the highest clinical severity scores but did not have higher rates of historical diagnoses of volume overload.ConclusionThe ED -based implementation of a sepsis tracking sheet and the involvement of dedicated ED pharmacists was effective in improving core measures of sepsis compliance. Patients receiving higher fluid aliquots did not experience higher rates of respiratory interventions, though had higher all-cause mortality. No relationship could be identified between patients getting lower aliquots of fluid and prior diagnoses of volume overload.© 2023. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).

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