Early recognition and treatment of non-traumatic shock in a community hospital

Interventions: From January 1998 to May 2000, patients in shock received standard therapy (control group). During the month of June 2000, intensive education of all healthcare providers (pre-hospital personnel, nurses and physicians) took place. From July 2000 through June 2001, patients in shock (protocol group) were managed with a hospital-wide shock program. The program used a systems-based team approach that consisted of five components: staff education to enhance early recognition and treatment of shock; empowerment of non-physician providers to mobilize hospital resources; rapid use of protocol-directed therapy; early involvement of intensivists; and prompt transfer of patients to the ICU. Goal-directed treatment protocols were utilized based on the “VIPPS” approach to shock, including: early support of ventilation and oxygenation; rapid infusion of volume; pharmacologic therapy, such as antibiotics and vasopressors; and disease specific interventions.