Successful prospective quality improvement programme for the identification and management of patients at risk of sepsis in hospital

Abstract

ObjectiveThis audit aimed to improve the speed and completeness of delivery of treatment to urology patients at risk of sepsis in the hospital.Patients and methodsPatients were prospectively included if they developed a new-onset systemic inflammatory response syndrome, were reviewed by a doctor who thought this was due to infection and prescribed antibiotics. We measured median time to antibiotic administration (TTABx) as the primary outcome. Factors associated with delays in management were identified, targeted quality improvement interventions implemented and then reaudited.ResultsThere were 74 patients in the baseline cohort and 69 following interventions. Median TTABx fell from 3.6 (1.9–6.9) hours to 1.7 (1.0–3.8) p<0.001 hours after interventions. In the baseline cohort, factors significantly associated with a delay in TTABx were: an Early Warning Score less than the medical review trigger level; a temperature less than 38°C; having had surgery versus not. Interventions included: reduced medical review trigger thresholds, education sessions, communication aids, a department-specific sepsis protocol. There were significant improvements in the speed and completeness of sepsis management. Improvements were most marked in postoperative patients. Improvement longevity was achieved through continued work by permanent ward nurse practitioners.ConclusionA period of baseline prospective study, followed by tailored quality improvement initiatives, can significantly improve the speed and quality of sepsis management for inpatients on an acute hospital ward.

Predictors for delayed antibiotic administration among bacteraemic patients in the Emergency Department: Differences between medical and surgical interns

“…An alarming finding was that the presence of fever and not hypotention was associated with more rapid administration of antibiotics. As previously shown, hyperthermic patients with sepsis receive antibiotics faster than normothermic or hypothermic, which was furthermore associated with increased mortality in the latter group 15 . In the absence of fever, clinicians appear reluctant or unable to recognize sepsis 10 …”

“…As previously shown, hyperthermic patients with sepsis receive antibiotics faster than normothermic or hypothermic, which was furthermore associated with increased mortality in the latter group. 15 In the absence of fever, clinicians appear reluctant or unable to recognize sepsis. 10 Rapid antimicrobial administration remains the cornerstone of the multifaceted management bacterial infections.…”

Impact of sepsis education for healthcare professionals and students on learning and patient outcomes: a systematic review

“…J o u r n a l P r e -p r o o f simulation only followed by debriefing sessions (n = 5) [41,56,[63][64][65], game-based learning (n = 4) [37,42,44,66], and multimodal (n = 8) [35, 36, 38-40, 46, 47, 59]. Didactic teachings were mostly in the form of presentation slides with case study discussions, with 11 studies using the traditional face-to-face classroom teaching approach [43, 45, 48-52, 54, 57, 61, 62] and four studies using the e-learning approach [53,55,58,60].…”

“…Apart from Qian et al [56] who used in-situ simulation, the other four simulation-only studies employed high-fidelity simulations [41,[63][64][65]. Three studies used digital game-based learning [42,44,66] and one study employed low-fidelity tabletop stimulation game-based learning [37]. Last, the multimodal approach (n = 8) included didactic pre-learning on the acquisition of knowledge prior to simulation sessions.…”

“…Bryant [38] and O'Shaughnessy et al [54] introduced the Situation, Background, Assessment, Recommendation communication tool, while Delaney et al [40] covered the TeamSTEPPS® communication and teamwork concepts in their sepsis education. The other four studies fostered an interprofessional teamwork approach to the management of septic patients in their simulation training [39,44,46,56].…”