Background: Sepsis is a leading cause of death in US hospitals, and is a major contributor to hospital mortality and length of stay. Much has been done in hospitals nationwide to identify and treat sepsis early. Similarly, at Bridgeport Hospital, a clinical redesign was initiated to identify and act on patients with signs of sepsis early in their clinical course. This redesign is unique in that it uses the rapid response team as the key party to intervene. This rapid response team is led by a Hospitalist provider.

Purpose: Reduce mortality and decrease length of stay by earlier assessment and interventions on patient with signs of sepsis

Description: When a patient is demonstrates predefined criteria which is suspicious for sepsis, an automated alert is fired to the Hospitalists Rapid Response Provider’s pager. This triggers a chart audit by that provider. If the patent is indeed deemed to be septic further laboratory tests, fluids, and antibiotics are ordered. If appropriate, a bedside assessment is performed and transfer to higher level of care is initiated.

Conclusions: Since the initiation of this project, length of stay in the sepsis population related diagnosis has fallen substantially from 7.2 in October of 2017 to 5.3 in June of 2018.
Additionally, mortality has also reduced dramatically. In 2018, average mortality in septic patients has dropped from 18.2 in 2017 to 15.85 (a decrease of almost 13%). The sepsis mortality continues to trend down each quarter, from 20% in quarter 1 of FY2018 to 10.8 in quarter 4 of FY2018 (a drop of 46%). We believe the key to success in this clinical redesign is the early involvement of the Hospitalist Rapid Response Provider as they have the appropriate clinical expertise needed.

IMAGE 1: Sepsis DRG Mortality Rate by quarter, FY 2017-FYTD

IMAGE 2: Average Length of Stay of Septicemia DRGs discharges by month, FYTD 2018