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Critical Care

Volume 12 Supplement 5

Sepsis 2008

Open Access

Use of clinical decision support to improve compliance with the Surviving Sepsis Campaign

  • Erica Cummings1,
  • Gerhard Tivig1,
  • LuAnn Staul2 and
  • Michele Lecardo3
Critical Care200812(Suppl 5):P3

Published: 18 November 2008


Decision Support SystemClinical Decision SupportClinical Decision Support SystemAntibiotic AdministrationSurvive Sepsis Campaign


Evidence suggests that early, timely and aggressive resuscitation for patients with septic shock can have a significant impact on both morbidity and mortality. However, even with the widespread awareness of the Surviving Sepsis Campaign (SSC) guidelines, adherence varies widely. It has been shown that clinical decision support systems can help clinicians improve various aspects of clinical practice, particularly when they are integrated into clinical practice and present at the point of care. Protocol Watch (PW) was developed as a bedside tool to assist clinicians with both implementation of and compliance with the SSC guidelines. The purpose of this research was to measure the impact that using PW had on adherence to the SSC guidelines.


Participants were critically ill patients in two large university-affiliated teaching hospital intensive care units in the United States. Prior to the installation of PW, implementation of the SSC guidelines was done using a paper-based system of standing orders. Baseline data on compliance with the SSC guidelines were collected. PW, which offers an electronic version of the guidelines and is resident on the bedside patient monitor, was then installed in all critical care beds. The post PW installation data collection is currently being collected.


Preliminary results show improvements in compliance with the resuscitation bundle, improved compliance with antibiotic administration, and a decreased time for completion of the resuscitation and management bundles and antibiotic administration (see Table 1). In addition, the feedback from the clinical users has been extremely positive.
Table 1

Mean values for age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, resuscitation/management bundle completion and antibiotic administration for initial subjects


Age (years)


Resuscitation bundle completion (time)

Management bundle completion (time)

Time to antibiotic administration (minutes)

Group 1 (n = 39), prior to PW



61.5% (11.6 hours)

85.2% (21.1 hours)


Group 2 (n = 46), after PW implementation



72.1% (9.1 hours)

85.3 (16.3 hours)



If the final data analysis supports the preliminary findings, PW could emerge as an important method for assisting in the implementation of the SSC guidelines, thus making a valuable contribution in the care of critically ill patients with sepsis.

Authors’ Affiliations

Philips Healthcare, Andover, USA
Lagacy Healthcare, Portland, USA
St Vincent's Hospital, Bridgeport, USA


© Cummings et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd.