Improving Outcomes in Patients With Sepsis

Abstract

Sepsis mortality may be improved by early recognition and appropriate treatment based on evidence-based guidelines. An intervention was developed that focused on earlier identification of sepsis, early antimicrobial administration, and an educational program that was disseminated throughout all hospital units and services. There were 1331 patients with sepsis during the intervention period and 1401 patients with sepsis during the control period. After controlling for expected mortality, patients in the intervention period had 30% lower odds of dying (odds ratio = 0.70, 95% confidence interval [CI] = 0.57 to 0.84). They also had 1.07 fewer days on average in the intensive care unit (95% CI = −1.98 to −0.16), 2.15 fewer hospital days (95% CI = −3.45 to −0.86), and incurred on average $1949 less in hospital costs, although the effect on costs was not statistically significant. Continued incremental improvement and sustainment is anticipated through organizational oversight, continued education, and initiation of an automated electronic sepsis alert function.

A Multidisciplinary Sepsis Program Enabled by a Two-Stage Clinical Decision Support System

“…This positive impact was driven by the sepsis program's purpose of risk reduction through early recognition and treatment, and corresponds to a 30% improvement in sepsis O/E outcomes, similar to other sepsis quality improvement initiatives. 39 The 2-stage sepsis CDS is an effective approach toward detecting and facilitating the management of patients with sepsis in a non-ICU setting by achieving broad adoption among providers, a finding shared by others who have implemented similar systems. 40 Definitions of sepsis CDS SIRS and severe SIRS alerts are robust, 30,33,34 as reported by clinimetric performance results in this study and previous publications.…”

A two-stage clinical decision support system for early recognition and stratification of patients with sepsis: an observational cohort study

“…Provider education with regards to the importance of early recognition was paramount when compared to a standalone technical solution. 18 Provider education was conducted prior to go-live; which included a live lecture series, an online teaching tool, navigating the EHR with the locally developed sepsis screening and stratification tool, and highlighting clinimetric performance of the CDS related to sensitivity and specificity.…”

Identifying the fundamental structures and processes of care contributing to emergency general surgery quality using a mixed-methods Donabedian approach

“…Structural components in this domain included the number and kinds of ICU beds and the critical care workforce (e.g., intensivists, respiratory therapists). Processes included in this domain included whether there were protocols to identify EGS patients requiring ICU admission, ensure 24/7 access to intensivist care, deploy rapid-response teams, and ensure adherence evidence based critical care guidelines [107,108]. Finally, the 'critical care resources' domain also included who provided intensive care to critically-ill EGS patients (i.e., operating surgeon, a surgical colleague, or another intensivist).…”