Sepsis is the leading cause of death among hospitalized patients in the United States, is responsible for more than 200,000 deaths annually, and has as high as a 50% mortality rate. Sepsis requires prompt identification so that early goal-directed therapy can be instituted to lead to better outcomes. The purpose of this quality improvement project was to determine if implementing an evidence-based identification and intervention program, Project Code Sepsis, in the emergency department can increase the number of patients who receive antibiotics within the first hour of triage and decrease the length of hospital stay. Specifically, the primary project goals were: (a) to administer initial antibiotic treatments within 1 hour of triage to more than 75% of patients, and (b) to reduce length of hospital stay to an average of less than 7 days. The project was developed from the Donabedian Healthcare Quality Triad and guided by the Six Sigma DMAIC method. A total of 306 patients were included in this project conducted from May to October 2015. The sepsis-screening tool was fully implemented during August when more than 75% of patients received their initial antibiotic within one hour of triage time. However, this accomplishment was not sustained during the next two months. Interestingly, August was also the month with the highest length of hospital stay (7.49 days) among sepsis patients. This quality improvement project did not show that the provision of antibiotic therapy within the first hour of triage time decreases the length of hospital stay among sepsis patients. Multiple factors including administration of intravenous fluids and vasopressors for hypotension, nurse and physician experiences, patient acuity, and local sepsis bacteria profile should be considered together in future studies and quality improvement projects.

Early Goal Directed Therapy (EGDT) has been thoroughly researched and clinically supported to be effective at lowering morbidity and mortality associated with severe sepsis and septic shock. Due to the strengths of its efficacy, it has been integrated as an essential component of the Surviving Sepsis Campaign. However, very few studies have explored the barriers that affect compliance of the protocol in actual practice. The purpose of this study was to synthesize current research findings regarding nursing barriers associated with EGDT. This research was limited to studies performed in the United States between 2003-2012, with patients at least 18 years old, and with data obtained from studies conducted within emergency departments (EDs) only. These findings may serve to help increase the compliance rate with the protocol among nurses in the ED. Findings indicated that compliance rates were mostly affected by two major barriers: 1) Lack of knowledge regarding the presentation and management of sepsis and septic shock, and 2)Lack of resources in the ED to perform the protocol to its full potential. Limitations of the review noted were that most research studies used were in major academic hospitals which limited the generalizability of the findings to other hospital settings. Nursing education should emphasize early recognition and aggressive treatment of sepsis. Future research should focus on addressing the most efficient ways to educate nurses on sepsis presentation and management and the ways these can be implemented in practice.