Despite recent improvement in knowledge of sepsis physiopathology, severe sepsis, and septic shock still represent a leading cause of death among inpatients all around the world. Although bundled care of sepsis has shown to improve patients outcome, sepsis protocols are difficult to implement due to their time–dependence and multidisciplinary features. Hospitalist model, which focuses on teamwork and effective communication as fundamental tools for patient safety and quality improvement, is an attractive framework for setting protocol–based care. We report the impact of a hospitalist–managed sepsis protocol and multidisciplinary teamwork on 28–day mortality rate in a Brazilian hospital.
In June 2010, a hospitalist–managed sepsis protocol was set in a 250–bed Brazilian hospital. Hospitalists leaded a multidisciplinary team composed by nurses, physiotherapists, pharmaceutics, radiologists, and laboratory attendants. This “Sepsis Team” was responsible for identifying, notifying, evaluating, treating, and transferring patients who developed sepsis during their stay in noncritical units. Hospitalists assumed the role of early response team, starting the “Sepsis Protocol” and triggering the “Sepsis Team” whenever recognized sepsis criteria in individuals with warning signs. First diagnostic and therapeutic interventions were driven by Surviving Sepsis Campaign guidelines. Hospitalists were also responsible for team continuous education and coordinated monthly meetings to review protocol results and to elaborate action plans. This study compares outcomes during the first semester of early protocol institution (Phase 1) and the second one of proactive management by hospitalists after exhaustive staff training and process alignment (Phase 2).
Overall, 149 cases of severe sepsis and septic shock were notified by hospitalists during the study period. Comparing Phase 1 with Phase 2, an increase of 36% in case notification (N = 64 vs N = 87; p < 0.005) and a significant reduction in 28–day mortality by 41.6% (49.3% vs 28.8%; p < 0.005) were seen during the second semester. Coinciding with mortality decreasing, a meaningful improvement in antibiotic early administration was registered (34% vs 73%; p < 0.005).
Hospitalist–managed sepsis protocol remarkably improved cases notification and patients outcome. Antibiotic early administration coincided with the survival benefit. Hospitalist model offers the opportunity of setting protocol–based interventions in noncritical units with relevant impact on patient safety, quality improvement, and even in–hospital mortality. While focusing teamwork and efficient communication, hospitalists can enhance managed care of inpatients and their most threatening conditions.