Abstract
Introduction Protocolized approaches to sepsis management, or "sepsis bundles," have been increasingly adopted by medical institutions to facilitate prompt treatment and improve outcomes. This study aimed to evaluate the effects of a protocolized sepsis algorithm to improve Centers for Medicare & Medicaid Services (CMS) hour-3 bundle compliance. Methods This retrospective, single-center study included patients aged≥ 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. The Code Sepsis program consists of a team-based algorithm of sepsis bundle components, including but not limited to clinical assessments, fluids, antibiotics, and laboratory studies, to enhance their timely completion in the emergency department. The primary outcome evaluated hour-3 bundle compliance. Secondary outcomes included hour-1 and hour-6 bundle compliance. Data were analyzed using SPSS Statistics v.29.0 (IBM Corp., Armonk, NY). Results A total of 118 patients were included in the study (59 PC vs. 59 AC). The mean patient age was 63 ±18 years; 45% were male, and 42% were diagnosed with septic shock. Hour-3 bundle compliance trended toward improvement (25% PC vs. 41% AC, p=0.07) and similarly observed for the hour-6 bundle (51% PC vs. 64% AC, p=0.13). Hour-1 bundle compliance significantly improved (10% PC vs. 24% AC, p=0.03). Hospital length of stay was significantly shorter after Code Sepsis (eight (0.7-50) days PC vs. five (0.4-34) days AC, p=0.005). No difference between in-hospital all-cause mortality (20% PC vs. 10% AC, p=0.13) or hospice disposition (8% PC vs. 2% AC, p=0.20) was observed. Conclusions Code Sepsis implementation was associated with a trend toward improved hour-3 and hour-6 bundle compliance, significantly improved hour-1 bundle compliance, and reduced hospital length of stay. Further prospective studies of protocolized approaches to sepsis management are required to determine the impact on mortality.