Ayad M, Karanth S, Narat M, Luther K, Patel B. Outcomes of creating an automated repeat lactate rule in sepsis patients with lactate levels ≥2. Poster presented at the 2019 Institute for Healthcare Improvement (IHI) Scientific Symposium; December 2019. Orlando, FL. [abstract] BMJ Open Qual. 2019; 8(Suppl 2):A39. doi: 10.1136/bmjoq-2019-ihi.23

BACKGROUND: Sepsis is a complex disease process that possesses a socioeconomic burden in the U.S.1 Serum lactate and lactate clearance form an important component of the sepsis resuscitation bundle2 and high levels correlate with worse outcomes.3 4 5 Previous studies emphasized the importance of utilizing lactate monitoring to guide resuscitation to improve mortality.6 7 Objectives We aimed to enhance lactate monitoring and lactate guided resuscitation in sepsis patients with lactate levels ≥2 mmol/L in order to improve outcomes.

METHODS: An EMR automated Q2 lactate repeat orders for sepsis patients who have an initial lactate level ≥2 mmol/L was implemented. Lactate dashboards showing all patient-level lactate values during initial resuscitation was incorporated into Hospital Sepsis Committee Multi-Disciplinary meetings.

RESULTS: We included 1774 adult sepsis patients admitted from the ED to MICU from October 2014 to September 2018 who had an initial lactate level ≥2 mmol/L. We aimed to compare the median time from ED arrival to lactate reduction to <2 mmol/L, median time from 1st elevated lactate result to lactate <2 mmol/L and the median length of stay (LOS). Post-intervention, the time from ED arrival to lactate <2 mmol/L for those patients with an elevated lactate significantly reduced by 10.56 hours and the time from first elevated lactate to lactate <2 mmol/L significantly reduced by 9.51 hours. LOS reduced by 3 days post intervention.

Implementing an automated repeat lactate order for sepsis patients along with a multi-disciplinary review of dashboards resulted in an improvement in lactate clearance and a reduction in LOS. Further studies are needed to investigate this finding.

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