Sepsis Alert: Pathway to Sepsis Innovation in the Emergency Department

Abstract

Session C presented Thursday, September 27, 1:00-2:00 pm Purpose: Severe sepsis and septic shock have a high mortality rate. Positive patient outcomes rely on the Emergency Department (ED) to play a vital role in early identification and time-dependent interventions. The goal for the ED Sepsis Alert Project was to facilitate early detection of patients who fit the Sepsis criteria, early initiation of Sepsis Bundle, and decrease mortality rates for sepsis patients. Design: This workflow was a two-tiered system within the ED that begins in triage. It begins by identifying the patient that meets sepsis criteria (2 SIRS criteria + source of infection), calling an alert to notify all staff/prioritizing care, immediately rooming the patient, and ensuring ED physician is at the bedside immediately (within 10 minutes) to assess the patient. The second component of the workflow involves physician assessment and determination of severity of illness/confirmation of identification of sepsis. The primary RN then carries out completion of sepsis bundle. Setting: Project setting is at an urban, non-profit hospital in Orange County, in the city of Anaheim, California. Participants/Subjects: All ED staff participated in this change in process improvement. Change in workflow applied to adult patients 18 years of age or older that met designated criteria. Methods: Education for OCA ED Staff was completed using daily huddles with staff (day, night, and mid-shifts) for two weeks prior to initiation of workflow. Subsequently, an audit process was developed and utilized on a weekly basis. Results/Outcomes: The data used to evaluate progress included initiation and completion of the Early Management Bundle for Severe Sepsis/Septic Shock per The Joint Commission (TJC) Core Quality Measure. This includes lactate draw within 1 hour, repeat lactate within 3 hours, antibiotic administration within 2 hours, and fluid resuscitation at 30ml/kg. Inpatient mortality is also evaluated for this population. Lactate draws within 1 hour prior to intervention (April 2016) was at 79% and increased post-intervention (July 2016) to 85%. Antibiotics within 2 hours prior to intervention (April 2016) was at 68% and increased post-intervention (July 2016) to 88%. Fluid bolus administration within 3 hours prior to intervention (April 2016) was at 56% and increased post-intervention (July 2016) to 73%. Facility inpatient mortality rates prior to intervention (April 2016) were at 22% (organization's regional rate: 20%) and decreased post-intervention (July 2016) to 11% (organization's regional rate: 15%). Implications: Early recognition and management of severe sepsis/septic shock optimizes outcomes. Prioritization and timely care of patients presenting to the ED that meet sepsis criteria leads to a decrease in mortality. The utilization of the Sepsis Alert workflow facilitated early detection of patients who fit the sepsis criteria, early initiation of the Sepsis Bundle, and a decrease in mortality rates.