{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:53:08Z","timestamp":1790790788715,"version":"4.1.0"},"reference-count":29,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T00:00:00Z","timestamp":1768608000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Sepsis is a critical medical emergency with significant morbidity and mortality, particularly in resource-limited countries. Effective strategies are essential to lower the high death rate. The sepsis code protocol recommends coordinated, structured, and prompt interventions for thorough patient care. This study aimed to compare in-hospital mortality rates after implementing the Sepsis Code protocol with those of a cohort of patients previously treated according to standard institutional guidelines. Methods: A pilot quasi-experimental study using a historical cohort design was conducted, involving patients with sepsis treated in an emergency department. Bivariate and multivariate analyses, as well as survival analysis, were conducted to evaluate the effectiveness of the intervention. Results: A total of 342 patients were analyzed. Among those who received the intervention, mortality was 13.4%, while in the control group, it was 22.5% (p = 0.042). Additionally, a protective association was found between the intervention and mortality (OR, 0.53; 95% CI, 0.29\u20130.94). Factors associated with increased mortality risk included lactate levels, SOFA score, septic shock presence, and history of diabetes. Conclusions: The implementation of the Sepsis Code in the emergency area showed an association with lower in-hospital mortality, especially in patients with septic shock. However, due to the study\u2019s design, further research is needed to employ more robust methodologies and confirm the protocol\u2019s applicability in the region.<\/jats:p>","DOI":"10.3390\/jcm15020767","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T08:36:33Z","timestamp":1768898193000},"page":"767","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Implementation of a Sepsis Code Protocol at an Academic Institution in Colombia: A Pilot Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5465-7479","authenticated-orcid":false,"given":"German","family":"Devia Jaramillo","sequence":"first","affiliation":[{"name":"Emergency Department, Hospital Universitario Fundaci\u00f3n Santaf\u00e9 de Bogot\u00e1, Bogot\u00e1 111321, Colombia"},{"name":"School of Medicine, Universidad del Rosario, Bogot\u00e1 111321, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura Mar\u00eda","family":"Castillo Morales","sequence":"additional","affiliation":[{"name":"Department of Critical Medicine and Intensive Care, Hospital Universitario Fundaci\u00f3n Santaf\u00e9 de Bogot\u00e1, Bogot\u00e1 111321, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7064-1765","authenticated-orcid":false,"given":"Camilo Antonio","family":"Vega Useche","sequence":"additional","affiliation":[{"name":"Department of Critical Medicine and Intensive Care, Hospital Universitario Fundaci\u00f3n Santaf\u00e9 de Bogot\u00e1, Bogot\u00e1 111321, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990\u20132017: Analysis for the Global Burden of Disease Study","volume":"395","author":"Rudd","year":"2020","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1016\/S1473-3099(17)30322-5","article-title":"The epidemiology of sepsis in Brazilian intensive care units (the Sepsis PREvalence Assessment Database, SPREAD): An observational study","volume":"17","author":"Machado","year":"2017","journal-title":"Lancet Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1097\/CCM.0b013e318218a35e","article-title":"The epidemiology of sepsis in Colombia: A prospective multicenter cohort study in ten university hospitals","volume":"39","author":"Barrera","year":"2011","journal-title":"Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"33","DOI":"10.2147\/OAEM.S289148","article-title":"USER Protocol as a Guide to Resuscitation of the Patient with Septic Shock in the Emergency Department","volume":"13","year":"2021","journal-title":"OAEM"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1056\/NEJMra1208623","article-title":"Severe sepsis and septic shock","volume":"369","author":"Angus","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"6234","DOI":"10.1038\/s41598-024-55667-5","article-title":"Identification of a hyperinflammatory sepsis phenotype using protein biomarker and clinical data in the ProCESS randomized trial","volume":"14","author":"DeMerle","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/CCM.0000000000006135","article-title":"Surviving Sepsis Campaign Research Priorities 2023","volume":"52","author":"Deutschman","year":"2024","journal-title":"Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1136\/emermed-2014-204465","article-title":"National early warning score at Emergency Department triage may allow earlier identification of patients with severe sepsis and septic shock: A retrospective observational study","volume":"33","author":"Keep","year":"2016","journal-title":"Emerg. Med. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1097\/CCM.0000000000005842","article-title":"Development and External Validation of the International Early Warning Score for Improved Age- and Sex-Adjusted In-Hospital Mortality Prediction in the Emergency Department","volume":"51","author":"Candel","year":"2023","journal-title":"Crit. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Damiani, E., Donati, A., Serafini, G., Rinaldi, L., Adrario, E., Pelaia, P., Busani, S., and Girardis, M. (2015). Effect of Performance Improvement Programs on Compliance with Sepsis Bundles and Mortality: A Systematic Review and Meta-Analysis of Observational Studies. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0125827"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s12245-024-00761-8","article-title":"Adjusting EWS scores for altitude above sea level: Is it necessary to predict sepsis mortality in the emergency room?","volume":"18","year":"2025","journal-title":"Int. J. Emerg. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"PRISM Investigators, Rowan, K.M., Angus, D.C., Bailey, M., Barnato, A.E., Bellomo, R., Canter, R.R., Coats, T.J., Delaney, A., and Gimbel, E. (2017). Early, Goal-Directed Therapy for Septic Shock\u2014A Patient-Level Meta-Analysis. N. Engl. J. Med., 376, 2223\u20132234.","DOI":"10.1056\/NEJMoa1701380"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1007\/s00134-015-3822-1","article-title":"A systematic review and meta-analysis of early goal-directed therapy for septic shock: The ARISE, ProCESS and ProMISe Investigators","volume":"41","author":"Angus","year":"2015","journal-title":"Intensive Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.medin.2016.08.001","article-title":"Impacto de la implantaci\u00f3n de un C\u00f3digo Sepsis intrahospitalario en la prescripci\u00f3n de antibi\u00f3ticos y los resultados cl\u00ednicos en una unidad de cuidados intensivos","volume":"41","year":"2017","journal-title":"Med. Intensiv."},{"key":"ref_17","first-page":"154","article-title":"En nombre del Grupo Sepsis Arag\u00f3n. Before-after study of the effect of implementing a sepsis code for emergency departments in the community of Aragon","volume":"29","year":"2017","journal-title":"Emergencias"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.chest.2021.07.2167","article-title":"Effects of Compliance with the Early Management Bundle (SEP-1) on Mortality Changes Among Medicare Beneficiaries With Sepsis","volume":"161","author":"Townsend","year":"2022","journal-title":"CHEST"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"543","DOI":"10.7326\/ANNALS-24-02426","article-title":"The Effect of Severe Sepsis and Septic Shock Management Bundle (SEP-1) Compliance and Implementation on Mortality Among Patients with Sepsis: A Systematic Review","volume":"178","author":"Ford","year":"2025","journal-title":"Ann. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1056\/NEJMoa1703058","article-title":"Time to Treatment and Mortality during Mandated Emergency Care for Sepsis","volume":"376","author":"Seymour","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1097\/01.CCM.0000217961.75225.E9","article-title":"Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock","volume":"34","author":"Kumar","year":"2006","journal-title":"Crit. Care Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1186\/s13054-025-05400-z","article-title":"Early norepinephrine for patients with septic shock: An updated systematic review and meta-analysis with trial sequential analysis","volume":"29","author":"Shi","year":"2025","journal-title":"Crit. Care"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Devia Jaramillo, G., Motta Hern\u00e1ndez, J.W., and Donoso Zapata, W.G. (2025). Norepinephrine Onset Time and Mortality in Patients with Septic Shock Treated in the Emergency Department. J. Clin. Med., 14.","DOI":"10.3390\/jcm14176025"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"On Behalf of the SPDM Against Sepsis Project, Machado, F.R., Ferreira, E.M., Schippers, P., de Paula, I.C., Saes, L.S.V., de Oliveira, F.I., Tuma, P., Filho, W.N., and Piza, F. (2017). Implementation of sepsis bundles in public hospitals in Brazil: A prospective study with heterogeneous results. Crit. Care, 21, 268.","DOI":"10.1186\/s13054-017-1858-z"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"279","DOI":"10.5935\/0103-507X.20220026-pt","article-title":"Compara\u00e7\u00e3o da propor\u00e7\u00e3o entre press\u00e3o venosa central menos arterial de di\u00f3xido de carbono e conte\u00fado de oxig\u00eanio arterial menos venoso central e n\u00edveis de lactato como preditores de mortalidade em pacientes cr\u00edticos: Uma revis\u00e3o sistem\u00e1tica e metan\u00e1lise","volume":"34","author":"Dubin","year":"2022","journal-title":"RBTI"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Lu, J., Dong, Z., Ye, L., Gao, Y., and Zheng, Z. (2025). Predictive value of SOFA, PCT, Lactate, qSOFA and their combinations for mortality in patients with sepsis: A systematic review and meta-analysis. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0332525"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1177\/0885066619889322","article-title":"Blood Glucose Levels and Mortality in Patients with Sepsis: Dose\u2013Response Analysis of Observational Studies","volume":"36","author":"Wang","year":"2021","journal-title":"J. Intensive Care Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1007\/s00134-010-1974-6","article-title":"The \u201ckoala stress syndrome\u201d and adrenal responsiveness in the critically ill","volume":"36","author":"Marik","year":"2010","journal-title":"Intensive Care Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Vandenbroucke, J.P., von Elm, E., Altman, D.G., G\u00f8tzsche, P.C., Mulrow, C.D., Pocock, S.J., Poole, C., Schlesselman, J.J., Egger, M. (2007). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration. PLoS Med., 4.","DOI":"10.1371\/journal.pmed.0040297"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/767\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T08:56:54Z","timestamp":1768899414000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/767"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,17]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15020767"],"URL":"https:\/\/doi.org\/10.3390\/jcm15020767","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,17]]}}}