Sepsis is the most common, costly and deadly diagnosis in U.S. hospitals, with one sepsis patient being diagnosed every 20 seconds. More people die from sepsis than from prostate cancer, breast cancer and AIDS combined. Yet only a little more than half of American adults have even heard of sepsis.
So what is it exactly? Sepsis is a body’s overwhelming and life-threatening response to infection. Severe sepsis is diagnosed when a patient has an infection plus additional signs of organ dysfunction. Nationally, approximately 40 percent of patients who have severe sepsis die.
Hospitals have been working to improve outcomes of care for patients with sepsis for several years. Early recognition and rapid intervention for these patients is critical to improve survival from this condition. In 2016, Vizient launched the Early Recognition and Intervention for Sepsis Management Collaborative. Participants improved the care for patients with sepsis in their organizations. Project teams that reported their compliance with a sepsis treatment bundle increased the number of patients who received all recommended care elements by 45 percent. The 72 organizations that participated in the collaborative experienced an overall decrease in sepsis mortality rate of 283 fewer deaths. In addition, these participants collectively avoided 6,421 patient days, which translates to an aggregate cost avoidance of over $14.7 million.
Here are some key takeaways from the collaborative for you to consider in your sepsis programs:
1. Screen every patient, every shift. There is truly no substitute for critical assessment by care providers – nurses, residents, attending physicians – all providers should assess the patient for signs and symptoms of sepsis. It can occur quickly and patients can deteriorate rapidly. In addition to routine screening, use additional tools in the background. For example, use or enhance a Systemic Inflammatory Response Syndrome (SIRS) alert, a modified early-warning score (MEWS), or a Sepsis Risk Score. Let the EMR support you in recognizing worrisome trends in patient vital signs.
Consider how you can recognize sepsis even before a patient arrives. Collaborate with your local emergency medical services to screen patients. If you know before arrival that the patient is septic, you can have orders ready to go when the ambulance pulls up.
2. Enlist critical care physicians as champions. A strong physician champion is the secret sauce. You won’t get very far without one. Critical care physicians and intensivists can make excellent champions – they ultimately get these patients in their care once admitted. One champion is essential. More than one is even better. Add in champions from all areas where sepsis patients are identified and treated, including the emergency department and the hospitalist service. Engage leaders from across all hospitals in your system.
3. Conduct focus groups to identify barriers and solutions. No one can tell you better than your bedside nurses and residents what’s not working and why sepsis treatment bundle elements get missed. Conduct focus groups with front-line staff to identify barriers and solutions to order set usage and protocol adherence. Have front-line staff provide feedback on any EMR workflows; ensure the work makes sense for bedside nurses. Implement changes quickly so that staff members recognize immediate effects of participation.
4. Create provider-friendly order sets. The more streamlined and simplified you can make order sets for patients with sepsis, the better. Include key labs to be drawn even if providers are not yet sure that the patient has sepsis. Include providers from all disciplines where sepsis is identified and treatment is started in order set creation – notably your emergency department, inpatient service and critical care. Ensure that trainees, including interns and residents, are encouraged and supported in using the tools available in your EMR.
September is national Sepsis Awareness Month. This is a great time to review what you’re doing for sepsis patients in your hospital. How do you recognize sepsis patients and intervene quickly? Are physicians engaged in sepsis improvement work? What additional suggestions do front-line staff members have to improve care? Are EMR order sets user-friendly enough to ensure consistent usage?
Vizient Performance Improvement Collaboratives bring together quality and performance leaders to collaborate on problem solving and empower action on the most critical aspects of health care performance. For more information about Vizient collaboratives, contact firstname.lastname@example.org.
About the author. Kate O’Shaughnessy has more than 15 years of varied health care industry experience, most recently managing and delivering national performance improvement projects, and publishing evidence-based best practices and action strategies to help more than 300 academic medical center members improve outcomes associated with clinical and operational challenges. Prior to joining Vizient, O’Shaughnessy served as a patient satisfaction consultant with Rush University Medical Center, and as an analyst and consultant with Accenture’s Health and Life Sciences division.