Recognizing a critical opportunity for quality improvement, a multispecialty group came began focusing on sepsis at the Beth Israel Deaconess Medical Center (one of the major teaching insitutions of Harvard Medical School) in the spring of 2003. That led to an institutional consensus on management of patients with severe sepsis and septic shock, which we called the Multiple Urgent Sepsis Therapies Protocol -- the MUST Protocol.

The protocol was based on a careful review of the existing literature -- especially early goal-directed therapy, activated protein C, and steroids. It brought nothing new to the table except careful planning and execution of nurse and physician education, and tools for in-the-trenches implementation of a fairly complex care pathway.

We spent a fair amount of time developing educational materials, flow sheets, and other tools to help us actually implement the MUST Protocol. We wanted these to be available to others; although each institution is different, we hoped that these might serve as a starting point for others. There's no point in reinventing the wheel if you don't need to -- you may as well work on developing a carburetor!

We initally made our MUST Protocol Guide available for download in February 2004. Since then, it has been downloaded several hundred times per month. We've since spoken directly or talked by email with literally dozens of providers who had questions or comments about the MUST Protocol and specifics of implementation. We've been particularly gratified that some of you have said the availability of our materials helped you implement sepsis treatment pathways at your own institutions.

This expanded website, and the materials below, represent our continuing efforts to make our sepsis educational and implementation materials broadly available.

It should -- but may not -- go without saying that critical care is a rapidly changing specialty that requires clinical expertise, profound attention to detail, and ongoing vigilance to maintain up-to-date knowledge.

This website, associated guides, and other materials were developed as educational tools and quick reference guides for practitioners already skilled in critical care. They are — under no circumstances — intended to replace ongoing medical knowledge, review of primary sources, and clinical judgment in each individual patient's case.

The Beth Israel Deaconess Medical Center retains the copyright and trademarks for the MUST Protocol, this website, and associated Guides. Individual practitioners, medical schools, and hospitals may use and reproduce up to 50 copies of these materials; this is a non-exclusive license. (We ask only that you let us know if you are using our materials.) Other entities should contact the authors if they wish to license the materials.

The Beth Israel Deaconess Medical Center retains the copyright and trademarks for the MUST Protocol, this website, and associated Guides. Individual practitioners, medical schools, and hospitals may use and reproduce up to 50 copies of these materials; this is a non-exclusive license. (We ask only that you let us know if you are using our materials.) Other entities should contact the authors if they wish to license the materials.

It should -- but may not -- go without saying that critical care is a rapidly changing specialty that requires clinical expertise, profound attention to detail, and ongoing vigilance to maintain up-to-date knowledge.

This website, associated guides, and other materials were developed as educational tools and quick reference guides for practitioners already skilled in critical care. They are — under no circumstances — intended to replace ongoing medical knowledge, review of primary sources, and clinical judgment in each individual patient's case.

The Beth Israel Deaconess Medical Center retains the copyright and trademarks for the MUST Protocol, this website, and associated Guides. Individual practitioners, medical schools, and hospitals may use and reproduce up to 50 copies of these materials; this is a non-exclusive license. (We ask only that you let us know if you are using our materials.) Other entities should contact the authors if they wish to license the materials.

Shapiro NI, Howell M, Talmor D. A blueprint for a sepsis protocol. Acad Emerg Med. 2005 Apr;12(4):352-9.

Shapiro NI, Howell MD, Talmor D, Lahey D, Ngo L, Buras J, Wolfe RE, Weiss JW, Lisbon A. Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol. Crit Care Med. 2006 Apr;34(4):1025-32.

Shapiro NI, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, Weiss JW. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005 May;45(5):524-8.

(in press)

Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW. Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule. Crit Care Med. 2003 Mar;31(3):670-5.

Kennedy M, Bates DW, Wright SB, Ruiz R, Wolfe RE, Shapiro NI. Do emergency department blood cultures change practice in patients with pneumonia? Ann Emerg Med. 2005 Nov;46(5):393-400.

Murray SB, Bates DW, Ngo L, Ufberg JW, Shapiro NI. Charlson Index Is Associated with One-year Mortality in Emergency Department Patients with Suspected Infection.Acad Emerg Med. 2006 Mar 21;