Background: Sepsis is a leading cause of morbidity and mortality in the US. Annually, over 250,000 people die from sepsis nationwide. Therefore, in 2013 New York State mandated that hospitals adhere to standardized protocols designed to improve sepsis outcomes. A recent cohort analysis on the rollout of these standards demonstrated that mortality decreased by 6% for each 10% increase in compliance with the composite sepsis bundle. At our hospital, we identified the reassessment component of the sepsis bundle as an area of opportunity to improve compliance, especially in the transition from the ED to inpatient teams. This component entails an exam of the patient to determine response to fluid resuscitation, need for further fluids or initiation of vasopressors, and appropriate related documentation. As it stands, the completion of the bundle is a shared responsibility between the emergency and inpatient teams. It must be completed within six hours. Gaps were noted in the communication of identified patients between the ED and inpatient team, as well as the incomplete bundle components that must be addressed in order to be compliant with DOH sepsis requirements. To decrease fallouts, failsafes were built into the sepsis process and were implemented by our hospitalist champions.
Purpose: To optimize hospitalist workflow and utilization of resources to increase sepsis bundle compliance.
Description: A multi-step process was developed to proactively identify potential sepsis patients in need of reassessment: 1. Education of senior medical admitting residents (MAR) to incorporate sepsis screening into their workflow for newly admitted patients 2. Adjusted the hospitalist patient database to prompt for sepsis status as a way to encourage recognition, facilitate internal auditing of data, and provide concurrent feedback as patients are transitioned through the medicine service. 3. Practice reinforcement through weekly education and training of the incoming MARs and relevant hospitalists regarding sepsis bundle and guidelines. Over time these methods were seamlessly ingrained into the hospitalist workflow.
Conclusions: A multipronged approach to add redundancy in the identification of appropriate sepsis patients to fulfill the sepsis bundle was implemented. A total of 431 patients admitted only to the hospitalist medicine service were identified as sepsis cases through this process from March to October 2019 at our institution. The overall compliance rate, for all hospitalized patients, with reassessment component of the sepsis bundle more than doubled from 11% in 2018 August YTD compared to 23% in 2019. The composite bundle adherence increased from 27% to 43%. We have successfully developed a process to improve sepsis bundle compliance by focusing our efforts on the reassessment domain. Similar methods can be adapted to enhance other low performing components including repeat lactate testing and completion of weight-based fluids.