- Poster presentation
- Open Access
IMPACT OF TRIALS ON CLINICAL PRACTICE: INTERVENTIONS IN SEPTIC SHOCK PATIENTS BETWEEN 2005 AND 2013
© Jones et al.; 2015
- Published: 1 October 2015
- Septic Shock
- Septic Shock Patient
- Survive Sepsis Campaign
- Protective Ventilation
- Lung Protective Ventilation
Evidence based medicine [EBM] at bedside, a key healthcare quality measure, refers to the compendium for delivering optimum clinical care by balancing benefit-harm-costs. EBM involves appraisal, interpretation and implementation with adoption of beneficial interventions and de-adoption of interventions with potential harm.
Our hypothesis from Niven et al  where the reversal of intervention effect was not associated with timely de-adoption, is that for a rapid change in clinical practice perceived cost [monetary or clinical harm] attributable to the intervention must be high.
Tight glucose control [TGC] and corticosteroids are examples of nonproprietary and recombinant Activated protein C [rt-APC] an example of proprietary intervention with reversal of effect between publications, from benefit to harm. All three interventions were part of the Surviving Sepsis Campaign [SSC] EBM .
We explored the impact of reversal of intervention effect in septic shock trials on the adoption - de-adoption cycle of these three interventions; hypothesis being visible 'cost' influences EBM.
Guy's and St. Thomas' NHS Foundation Trust (London, England) is a 1,150-bed, University hospital with closed mixed medical and surgical ICUs and an early adopter of the SSC. Trained data collectors prospectively recorded all ICU admissions with severe sepsis/septic shock (SS) [2005 to 2013] into the SSC database. We report the adoption - de-adoption cycle of the interventions with effect reversal [rt-APC, corticosteroids, TGC] or unchanged (Antibiotics < 3hours; lactate measurement < 6 hours and lung protective ventilation [LPV]) over this period, relative to seminal publications for each intervention in septic shock patients.  As an on-going hospital approved audit since inception, informed consent was waived. Data analysis was performed using Stata v13.1 (StataCorp, LP).
This descriptive analysis supports our hypothesis. Further analysis will identify key drivers for 'timely' EBM beyond SSC bundle compliance.
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