Introduction. Diagnostic and therapeutic guidelines, organized as sepsis bundles, have been shown to improve mortality, but timely and consistent implementation of these can be challenging. Our study examined the use of a screening tool and an early alert system to improve bundle compliance and mortality. Methods. A screening tool was used to identify patients with severe sepsis or septic shock and an overhead alert system known as Code SMART (Sepsis Management Alert Response Team) was activated at the physician’s discretion. Data was collected for 6 months and compliance with bundle completion and mortality were compared between the Code SMART and non-Code SMART groups. Results. Fifty eight patients were enrolled ？34 Code SMART and 24 non-Code SMART. The Code SMART group achieved greater compliance with timely antibiotic administration ( ), lactate draw ( ), and steroid use ( ). Raw survival and survival adjusted for age, leucopenia, and severity of illness scores, were greater in the Code SMART group ( , , and ). Conclusions. A screening tool and an alert system can improve compliance with sepsis bundle elements and improve survival from severe sepsis and septic shock. 1. Introduction Sepsis is one of the leading causes of mortality worldwide. Over 750,000 hospitalizations occur in the United States each year, with approximately 200,000 deaths [1]. Because of such high mortality, guidelines known as Early Goal Directed Therapy (EGDT) were developed to increase sepsis awareness and direct therapy, thereby reducing mortality [2]. The Surviving Sepsis Campaign subsequently classified EGDT elements into a sepsis resuscitation bundle and a sepsis management bundle [2]. These bundles direct specific diagnostic and treatment strategies within designated time frames. Better outcomes have been demonstrated when compliance with bundle elements is high [3]. Consistent implementation of sepsis bundles has been challenging. Noncompliance with sepsis bundles has been demonstrated to increase in-hospital mortality for septic patients, while compliance with the resuscitation bundle, even if extended from the recommended time frame, decreases mortality [4, 5]. We sought to develop an easy to implement, low-cost system that would increase bundle compliance and improve survival. This was initially developed as a quality improvement initiative and ultimately became a standard of care in our facility. We hypothesized that the use of an early alert system that brought an interdisciplinary team rapidly to the patient’s bedside would increase compliance with bundle elements
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