Improving timely sepsis care using the surviving sepsis campaign one-hour bundle in a rural emergency department

Abstract

Background: Sepsis is deadly when not recognized and treated in a timely manner and leads to 270,000 deaths each year in America. Mortality increases eight percent for each hour treatment is delayed. Sepsis-related admission is the most expensive condition in the United States with a median cost per patient of $32,421. Local problem: Baseline data for patients with sepsis revealed that only 30% were recognized in triage, only 20% received correct amounts of fluids, and only 45% received antibiotics within one hour. The aim of this project was to improve timely sepsis care to 75% for patients in a rural emergency department within 90 days. Methods: A rapid cycle quality improvement project was completed, consisting of four plan-do-study-act cycles over 90 days. Each cycle included tests of change related to team and patient engagement, screening, and the use of timely sepsis orders. Data were collected three times weekly and analyzed using run charts. Interventions: Interventions included screening in triage with positively screened patients receiving participatory education, team handoff communication, a sepsis checklist for nurse-driven orders, and Power Hour for timely care. Results: Team communication improved to 83%. Patient education exceeded goal, with 100% of patients taking an active role in care. Sepsis screening improved to 100%. The recommended One-Hour Bundle for timely sepsis treatment improved to 83%. Conclusion: The project was successful in improving patient and team engagement, screening, and sepsis care within 1 hour for emergency department patients.

A mixed-methods descriptive study on the role of continuous quality improvement in rural surgical and obstetrical stability: Considering enablers, challenges and impact

“…This is reflected through the growing interest in and use of Donabedian’s model for quality of care, a scheme that considers structure, process, outcome and experience when defining and measuring quality and quality improvement in health care organizations [ 3 ]. Within this attention to quality care, growing research has emphasized the importance of provider-driven initiatives examining and responding to each of these domains of quality [ 4 – 6 ] to ensure relevance to local conditions. This is particularly salient in rural settings where local practice conditions may vary from larger centres where CQI models are built and implemented, and where additional resources may be needed (e.g., to travel and locum relief to participate in regional CQI events).…”

“…Existing evaluations of rural CQI initiatives are often provider-led [ 5 , 6 ] and benefit from on-the-ground leadership. Research suggests a focus on quality improves providers’ clinical knowledge and competence [ 19 , 25 ] as well as patient outcomes [ 21 , 26 ].…”

“…Research suggests a focus on quality improves providers’ clinical knowledge and competence [ 19 , 25 ] as well as patient outcomes [ 21 , 26 ]. In some studies, the quality of care has been shown to improve through facilitating more timely access to the right care by the right person in the right place [ 6 , 20 , 27 , 28 ]. Quality initiatives have also been shown to increase provider efficiency [ 7 ] and local team function [ 5 , 19 , 29 ] and increase adherence to best practice guidelines and clinical protocols [ 6 , 29 ], in some instances resulting in reduced costs [ 6 , 26 ].…”

“…This can be done through the use of networks to build regional “culture[s] of quality improvement” [ 8 , Conclusion, para.2]. Most noted, however, is the value of a local champion [ 11 ] and the importance of initiatives being provider-driven [ 6 ], the latter facilitated by incentives for participation, financial support, administrative support and a supportive organizational culture [ 11 ].…”