1. No Longer the Land of Confusion THEGENESISPROJECT

2. GENESIS 3. The GENESIS Writing Group 4. Background 500,000 cases of severe sepsis & septic shock annually in the US Severe sepsis mortality is about 20% Septic shock mortality is about 45% From 1995 to 2005, hospital costs have increased 183% The annual cost is $54 billion The majority of septic patients are identified in the ED Improved survival rates are achieved with diseases of similarvolume such as CVA, AMI and Trauma, by early identification, riskstratification and rapid therapeutic interventions 5. Impact of Severe Sepsis 6. Sepsis ResuscitationBundle-RBEGDT 7. EGDTRivers et al. NEJM 2001; 345:1368-77 8. Mortality Benefit is Maintained Rivers et al. NEJM 2001; 345:1368-77 9. Last Decade in SepsisManagementJfdfjdk 10. Summary of ImplementationStudies 11. EGDT at a CommunityHospital390USE OF GOAL-DIRECTED THERAPY FOR SEVERE SEPSIS AND SEPTIC SHOCK IN A LOGO COMMUNITY HOSPITAL LOWERS RESOURCE CONSUMPTION AND COST LOGOAaron Joffe1, Nathan Lidsky1, and Tudy Hodgman 1,2Northwest Community Hospital 1, Midwestern University, Chicago College of Pharmacy2INTRODUCTIONRESULTS EGDT for severe sepsis and septic shock improves patient Resource consumption Cost per hospital day ofoutcomes Differential cost inbefore and after implementation septic shock survival versus non-survivorof Sepsis inititativeThere is legitimate concern that putting EGDT into practice may2250055005000 Variable cost (dollars) 20000require greater utilization of hospital resources up-front. 15.0 Pre4500Variable cost ($) 17500 Post150004000 Therefore hospitals & clinicians may be reluctant to allocate12.53500 125003000enough resources for successful implementation10.0 10000N=95 Days7500 p=0.15 2500 7.5N=692000 $3,380The overall high mortality in this population, and the perception5000 5.0 *p=0.0225001500that non-survivors incur greater costs, only magnifies these 2.5 * 01000 500concerns 0.0 Survivor Non-Survivor 0SurvivorNon-survivor Pressors Vent ICU-LOS Hos-LOS HYPOTHESIS Resource ICU-LOS(d)Hospital-LOS(d)Ventilation(d) Pressors(d)Variable Cost($) Signif. level NSNSp=0.02NSNSAs an EGDT program becomes accepted, entrenched andPre (N=59)7.513.0 5.6 1.8 19,400 refined over time, there may be reduced sepsis-associatedPost (N=135) 5.010.1 2.8 1.5 14,220 morbidity which should translate into reduced resource utilization and costFor Survivors, mean cost was $17,990 ($1,380/day). A consistent and aggressive EGDT approach will lead to the perception by ICU personnel and patient/family that state of the For NS, mean cost was $13,380 ($3,380/day) ,p=0.15. art medicine for sepsis is being practiced.Withdrawal accounted for 68.5% of the overall mortality in the pre group This perception may allow more timely EOL discussions in the cohort of patients not responding to therapy in the first 2-3 days.vs. 66.6% in the post Thus, the cost of care in non-survivors may decrease. CONCLUSIONS MATERIALS AND METHODSWe compared resource utilization between a group of 59 QI efforts aimed at tine tuning the process of EGDT were associated withpatients prior to and 135 patients following implementation of a strong trends toward reduction in ICU and hospital resources, as well as cost savings.sepsis bundle initiative, which involved education, clear roleassignment, order-set prompts and data collection In our Non-survivor group, up-front resource allocation & cost was higher, butUtilized non-parametric tests; p