Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED

Am J Emerg Med. 2016 Jan;34(1):1-9. doi: 10.1016/j.ajem.2015.08.039. Epub 2015 Aug 28.


Background: Early identification of sepsis in the emergency department (ED), followed by adequate fluid hydration and appropriate antibiotics, improves patient outcomes.

Objectives: We sought to measure the impact of a sepsis workup and treatment protocol (SWAT) that included an electronic health record (EHR)-based triage sepsis alert, direct communication, mobilization of resources, and standardized order sets.

Methods: We conducted a retrospective, quasiexperimental study of adult ED patients admitted with suspected sepsis, severe sepsis, or septic shock. We defined a preimplementation (pre-SWAT) group and a postimplementation (post-SWAT) group and further broke these down into SWAT A (septic shock) and SWAT B (sepsis with normal systolic blood pressure). We performed extensive data comparisons in the pre-SWAT and post-SWAT groups, including demographics, systemic inflammatory response syndrome criteria, time to intravenous fluids bolus, time to antibiotics, length-of-stay times, and mortality rates.

Results: There were 108 patients in the pre-SWAT group and 130 patients in the post-SWAT group. The mean time to bolus was 31 minutes less in the postimplementation group, 51 vs 82 minutes (95% confidence interval, 15-46; P value < .01). The mean time to antibiotics was 59 minutes less in the postimplementation group, 81 vs 139 minutes (95% confidence interval, 44-74; P value < .01). Segmented regression modeling did not identify secular trends in these outcomes. There was no significant difference in mortality rates.

Conclusions: An EHR-based triage sepsis alert and SWAT protocol led to a significant reduction in the time to intravenous fluids and time to antibiotics in ED patients admitted with suspected sepsis, severe sepsis, and septic shock.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Clinical Protocols*
  • Electronic Health Records
  • Emergency Service, Hospital*
  • Female
  • Fluid Therapy*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Sepsis / diagnosis*
  • Sepsis / mortality
  • Sepsis / therapy*
  • Time Factors
  • Triage*


  • Anti-Bacterial Agents