Mortality Rate Among Patients With Septic Shock After Implementation of 6-hour Sepsis Protocol in the Emergency Department of Thammasat University Hospital

J Med Assoc Thai. 2014 Aug;97 Suppl 8:S182-93.


Background: Septic shock is a major healthcare problem effecting people worldwide with high mortality rate. Administering early and appropriate interventions can help improve the outcome. The 6-hour bundle, launched by the Surviving Sepsis Campaign committee was part of efforts to incorporate evidence-based guideline to clinical practice. There were many reports on outcome improvement of septic shock patients after implementation of the 6-hour bundle at the emergency department.

Objective: To compare mortality rate of septic shockpatients before and after implementing the 6-hour sepsis protocol at the emergency department of Thammasat University Hospital.

Material and methods: Study was conducted at the emergency department of Thammasat University Hospital. This is an interrupted time, before and after study, comparing between the prospective cohort period after (Oct 2012 to Nov 2013) and the historical control period before (Feb 2011 to July 2012) implementation of 6-hour sepsis protocol. Primary outcome was hospital mortality of septic shock patients. Secondary outcomes included length of hospital stay and predictive factors for mortality ofseptic shock patients.

Results: There were 80patients included in the pre-intervention group and 75patients in the post-intervention group. There was significant improvement in management of septic shock patients. Totalfluid given in 2 hours in the post-intervention group was significantly higher[2,000 (500-3,000) vs. 1,600 (100-3,600);p = 0.038)] when compared with thepre-intervention group. The entire resuscitation bundles compliance rate was significantly increased in the post-intervention group (37.3% vs. 0%; p<O. 001). Regarding each intervention in the 6-hour bundle, included serum lactate measurement, giving fluid bolus ≥500 ml and maintaining MAP≥65 mmHg, were all significantly increased in rate ofcompliance (96.0% vs. 2.5%; p<0.001, 100.0% vs. 92.3%;p = 0.029, 100.0% vs. 88.8%;p = 0.003, respectively). Hospital mortality was reduced significantly after implementation of the 6-hour sepsis protocol (18.7% vs. 40.0%; p = 0.005).

Conclusion: Septic shock mortality was decreased after implementation of the 6-hour sepsis protocol at the emergency department of Thammasat University Hospital.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Clinical Protocols*
  • Cohort Studies
  • Disease Management
  • Early Medical Intervention / methods*
  • Emergency Service, Hospital
  • Female
  • Fluid Therapy
  • Guideline Adherence
  • Hospital Mortality*
  • Hospitals, University
  • Humans
  • Interrupted Time Series Analysis
  • Lactic Acid / blood
  • Length of Stay
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Prospective Studies
  • Resuscitation
  • Shock, Septic / blood
  • Shock, Septic / mortality*
  • Shock, Septic / therapy*
  • Thailand
  • Treatment Outcome


  • Lactic Acid