Standardized order sets for the treatment of severe sepsis and septic shock

Evaluation of: Thiel SW, Asghar MF, Micek ST, Reichley RM, Doherty JA, Kollef MH. Hospital-wide impact of standardized order set for the management of bacteremic severe sepsis. Crit. Care Med. 37(3), 819-824 (2009). Aggressive standardized diagnostic and therapeutic approaches to acute diseases such as acute myocardial infarction, trauma and stroke have led to improved patient survival. A standardized order set for severe sepsis and septic shock represents a similar approach. In 2001, Rivers et al., using a standardized operating procedure to treat severe sepsis and septic shock, showed a relative risk reduction of 0.34 and absolute risk reduction of 16%, with a decrease in healthcare resource consumption for patients presenting to the emergency department. Since then, similar studies have shown similar or better results. This study in particular highlights a hospital-wide initiative that further confirms that standardized order sets and operating procedures for severe sepsis and septic shock result in a significant reduction in morbidity, mortality and healthcare resource consumption. With these robust findings, future emphasis should be placed on overcoming logistical, institutional and professional barriers to the implementation of standardized order sets, which can save the life of one out of every five to six patients presenting with severe sepsis and septic shock.