1. No Longer the Land of Confusion
THE
GENESIS
PROJECT

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 similar
volume such as CVA, AMI and Trauma, by early identification, risk
stratification and rapid therapeutic interventions

5. Impact of Severe Sepsis

6. Sepsis Resuscitation
Bundle-RB
EGDT

7. EGDT
Rivers et al. NEJM 2001; 345:1368-77

8. Mortality Benefit is Maintained
Rivers et al. NEJM 2001; 345:1368-77

9. Last Decade in Sepsis
Management
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10. Summary of Implementation
Studies

11. EGDT at a Community
Hospital
390
USE OF GOAL-DIRECTED THERAPY FOR SEVERE SEPSIS AND SEPTIC SHOCK IN A
LOGO COMMUNITY HOSPITAL LOWERS RESOURCE CONSUMPTION AND COST LOGO
Aaron Joffe1, Nathan Lidsky1, and Tudy Hodgman 1,2
Northwest Community Hospital 1, Midwestern University, Chicago College of Pharmacy2
INTRODUCTION RESULTS
EGDT for severe sepsis and septic shock improves patient Resource consumption Cost per hospital day of
outcomes
Differential cost in
before and after implementation septic shock
survival versus non-survivor
of Sepsis inititative
There is legitimate concern that putting EGDT into practice may 22500 5500
5000
Variable cost (dollars)
20000
require greater utilization of hospital resources up-front. 15.0 Pre 4500
Variable cost ($)
17500
Post 15000 4000
Therefore hospitals & clinicians may be reluctant to allocate
12.5 3500
12500
3000
enough resources for successful implementation
10.0 10000 N=95
Days
7500
p=0.15 2500
7.5 N=69 2000
$3,380
The overall high mortality in this population, and the perception
5000
5.0 *p=0.02 2500
1500
that non-survivors incur greater costs, only magnifies these 2.5
* 0
1000
500
concerns 0.0 Survivor Non-Survivor 0
Survivor Non-survivor
Pressors Vent ICU-LOS Hos-LOS
HYPOTHESIS Resource ICU-LOS(d) Hospital-LOS(d) Ventilation(d) Pressors(d) Variable Cost($)
Signif. level NS NS p=0.02 NS NS
As an EGDT program becomes accepted, entrenched and Pre (N=59) 7.5 13.0 5.6 1.8 19,400
refined over time, there may be reduced sepsis-associated Post (N=135) 5.0 10.1 2.8 1.5 14,220
morbidity which should translate into reduced resource utilization
and cost •For 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 METHODS
We compared resource utilization between a group of 59 QI efforts aimed at tine tuning the process of EGDT were associated with
patients 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 role
assignment, order-set prompts and data collection • In our Non-survivor group, up-front resource allocation & cost was higher, but
Utilized non-parametric tests; p<0.05 was significant overall cost was contained by earlier withdrawal of life support
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12. Meta analysis of GDTs
Early vs Late Strategies
Jones et al. CCM 2008;36:2734-9

13. WOW