Multidisciplinary Approach to Improve Sepsis Outcomes

Abstract

Severe sepsis and septic shock cause significant morbidity and mortality with health care costs approximating $17 billion annually. The Surviving Sepsis Campaign 2012 recommended time-sensitive care bundles to improve outcomes for patients with sepsis. At our community teaching hospital, a review of sepsis management for patients admitted to a medical intensive care unit (ICU) between December 2015 and March 2016 found 70.8% compliance with timing of lactate draw, 65.3% compliance for blood cultures, and 51.4% compliance with antibiotic administration recommendations. Thus, a quality improvement initiative to improve detection and time to bundle completion for ICU-level patients was designed. Previous studies suggest that utilization of sepsis alert systems and sepsis response teams in the emergency department setting is associated with improved compliance with recommended sepsis bundles and improved hospital mortality. Therefore, a “sepsis alert” protocol was implemented that used both an electronic alert and an overhead team alert that mobilized nursing, pharmacy, phlebotomy, and a senior internal medicine resident to bedside. In addition, a template to document sepsis diagnosis and bundle adherence was created. After implementation, we noted improvement in appropriately timed serum lactate, 88.6% versus 70.8% (p = .008) with no significant improvements in blood cultures, antibiotic administration, or mortality.

Pharmacist involvement in sepsis response and time to antibiotics: A systematic review

“…An additional study was identified from the review of bibliographies of these previously retained studies for a total of 10 studies included in this systematic review (Figure 1). 12‐21 These 10 studies include 1772 patients with sepsis or septic shock, were conducted during 2006‐2019, and published during the time period of 2008‐2022.…”

“…Pharmacists were specifically identified as key participants in all included studies per the inclusion criteria of the systematic review. Eight studies specifically noted a pharmacist responding to the bedside and interacting with other members of the health care team to consult and facilitate antibiotic order placement and verification, 13‐19,21 one study described pharmacists “huddling” with providers when notified of a sepsis notification, 20 and one study described pharmacists calling the nursing unit if no antibiotics were placed after 15 min of a sepsis alert and facilitating antibiotic ordering if needed, including a protocol which allowed for the pharmacist to select antibiotics if the provider was engaged in other aspects of care 12 . Six studies compared a sepsis bundle response or sepsis quality improvement initiative which included a pharmacist in some capacity, with the comparator group representing prior or concurrent care of sepsis patients without the bundle or quality improvement initiative (eg, historical control) 12‐14,16,17,19 .…”

Resuscitation Resident Impact in the Treatment of Sepsis

“…Studies have demonstrated a BPA leading to decreased time to antibiotics and other parameters [14][15], nevertheless, it did not lead to an improvement in mortality [14][15]. Personnel driven models, either with a sepsis response team or triage protocol, have also had varying degrees of success with decreasing time to sepsis bundle parameters [7][8][9][10][11], with only one demonstrating a possible mortality benefit [16]. Overall, similar to our study, the vast majority of these interventions have led to some improvement in achieving different sepsis core measurements [7][8][9][10][11][13][14][15][16][17].…”

“…Achieving the initial sepsis core-bundle within three hours can be challenging, and sepsis may not always be obvious based on the initial presentation. For this reason, a variety of approaches have been developed to maximize adherence to the sepsis core measures [7][8][9][10][11]. One method that could conceivably improve sepsis bundle achievement is having additional staff specifically designed to help with the resuscitation of patients that are critically ill. At our institution, we have developed a novel one-month rotation dedicated to resuscitative care in the ED [12].…”

Knowledge and role of dermatologists in life‐threatening infections: a national survey among hospital skin specialists

“…Finally, the involvement of different professionals in the sepsis alert and severe infection protocols has shown an improvement in the prognosis of these patients beyond the high dependency units. 8,9 Therefore, the inclusion of hospital dermatologists in these multidisciplinary teams could result in better care of patients with severe skin diseases exposed to a higher infectious risk and admitted to dermatology wards (e.g. autoimmune blistering diseases, atopic dermatitis or hidradenitis suppurativa, among others).…”