Background: Sepsis remains a serious worldwide health condition directly associated with high mortality rates, despite improvements in the ability to treat and manage infections. Since 2002, the Surviving Sepsis Campaign (SSC) has been a global effort to reduce patient mortality from severe sepsis and septic shock. The SSC has provided health care systems and providers with evidence based guidelines published and updated over the past 13 years to improve their management of these patients. It remains up to independent hospitals to develop systems with which to meet the standard goals of care in managing patients with severe sepsis and septic shock.
Methods: At our academic hospital, our Rapid Response Team (RRT) performed a needs assessment of severe sepsis and septic shock occurring on our general hospital wards. During the five years prior to implementation of our Sepsis Screening and Early Intervention Initiative, signs of severe sepsis or septic shock were frequently noted in patients requiring rapid response activation or transfer to intensive care. This led to concern that early signs and symptoms of sepsis were often going unrecognized, resulting in delayed intervention and adverse or less than optimal health outcomes for patients. The RRT performed a retrospective chart review March 2010-October 2010 on 112 consecutive RRT calls for sepsis. Alarmingly, 89 (80%) of these 112 patients were found to have severe sepsis or septic shock. It was hypothesized that an interdisciplinary initiative which included sepsis education, a standardized screening program, and a clearly identified evidence-based standard of care practice guideline would result in improved health outcomes for patients. We developed online education modules, performed educational lecture presentations to increase sepsis education. We developed an EMR based inpatient screening tool and treatment flowchart for the hospital system performed by RNs on every patient, every shift. All positive sepsis screens lead to provider notification for simple sepsis and to the RRT for severe sepsis. Providers then were instructed to utilize the inpatient flowchart for guidelines of sepsis treatment. We have reviewed UHC data to compare our hospital with other Academic Medical Centers (AMCs), starting January 2012 to January 2015. The endpoints we monitored were the sepsis diagnosis rate, sepsis mortality rate and ICU days for sepsis per 1000 patient discharges over that period.
Results: Results showed an increase in sepsis identification from 53 to 83 patients per 1000 discharges. The sepsis related mortality index decreased from 1.1 to 0.81 and the mean ICU days for sepsis patients decreased from 6.9 to 5.5 ICU days over the same period.
Conclusions: Utilizing a real time RN based screening tool to identify early sepsis can be a model for successful a systems-wide change. Our project over a 3 year period resulted in significant improvements in identifying sepsis as noted by an increase in sepsis diagnosis rate, reduction in sepsis mortality rate and a reduction in ICU days for sepsis.