Steve Hubbard, MD, a retired thoracic surgeon who now consults on quality for the hospital, says that "Even though we had read the articles, it didn't really occur to us how important it was to get the antibiotics in within an hour or two, and we didn't understand that it was important to give enough IV fluids that certain blood levels would change or other measurements would change."
"The Quest project put us in touch with other hospitals who had successfully given a lot of IV fluids towards a targeted goal, and when we started doing that, that's when we saw our mortality rate come down," he said.
Hubbard says hospitals with low mortality rates had procedures in place so that when patients came in through the ED, they were promptly asked a series of questions. "If two or three are positive, it turns on the light bulb that this patient might have a life-threatening infection," Hubbard says.
The hospital launched an "early sepsis bundle" which includes a key ingredient, serum lactate screening.
"In the 'old days,' those same questions would have been asked, and recorded, and the patient would have waited until a physician came around to see them," Hubbard says. "And eventually they would have gotten a series of tests and then someone would say, 'Gosh, maybe this patient is infected because they have a high fever,' and the patient would have been sent to a hospital floor and gotten sicker and sicker."
Andrus estimates that even if the patient didn't die right away, he or she would be "in the hospital four or five weeks, a lot of it in the ICU. And that probably cost the healthcare system $100,000 to $150,000."