An Interdisciplinary Code Sepsis Team to Improve Sepsis-Bundle Compliance: A Quality Improvement Project |
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| Institution: | 1. Yale–New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, CT;2. Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT;3. Herbert Wertheim College of Medicine, Florida International University, Miami, FL;4. Department of Emergency Medicine, University of Tennessee College of Medicine, Chattanooga, TN;5. Department of Surgery, Acute and Critical Care Surgery and Department of Medicine, Emergency Medicine, Washington University, St. Louis, MO;6. Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA;7. American College of Emergency Physicians, Washington, DC;8. Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA;9. Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA;1. University of Kansas School of Medicine, Kansas City, KS;2. Department of Biostatistics, University of Kansas, Kansas City, KS;3. Department of Preventive Medicine and Public Health, University of Kansas, Kansas City, KS;4. Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Kansas, Kansas City, KS;1. Department of Surgery, George Washington University, 2150 Pennsylvania Avenue, NW 6B, Washington, DC 20037, USA;2. Department of Internal Medicine, George Washington University, 2150 Pennsylvania Avenue, NW 6B, Washington, DC 20037, USA |
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| Abstract: | ProblemSepsis is one of the leading causes of mortality, with more than 700,000 hospitalizations and 200,000 deaths annually. Various tools exist to aid in the early identification and treatment of sepsis, including electronic alert systems, standardized order sets, nurse-initiated protocols (NIPs) and specially trained teams. Despite available guidelines, mortality rates for severe sepsis and septic shock are near 50%.MethodsThe aims of this rapid cycle quality improvement project were to develop and implement an interdisciplinary team to address early implementation of sepsis bundles in the emergency department and to compare sepsis bundle compliance 3 months pre- and 3 months postintervention implementation. The population included all patients above 18 years of age presenting to the emergency department with clinical indications of sepsis, severe sepsis, or septic shock. Data were collected via electronic health records (EHRs), switchboard-paging records, and a billing database.ResultsThe pre-post intervention analysis shows an improvement in time to each bundle element except antibiotics and completion of blood cultures. There were noteworthy changes in meeting bundle compliance in fluid resuscitation volume (χ2 = 16.3, P ≤ 0.001): initial lactate collected within 180 min (χ2 = 11.3, P ≤ 0.01) and time to second lactate within 360 min (χ2 = 27.7, P ≤ 0.001). Mortality rates showed a steady decline from over 12% to 5%. No differences were found in mortality rates related to age or gender.DiscussionInterprofessional teams can use existing knowledge, skills, and tools to improve sepsis-bundle compliance and mortality outcomes in patients with sepsis presenting to the emergency department. |
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| Keywords: | Interdisciplinary Sepsis alert Code sepsis Emergency department |
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