Amanda Holyk, BCCCP, PharmD
Mount Nittany Medical Center
State College, Pennsylvania
Disclosure information not submitted.
Susan Maynard, DNP, MS, RN-BC, CCNS-CMC, CCRN-K
Stroke Coordinator
Mount Nittany Medical Center, United States
Disclosure information not submitted.
Sameer Sinha, MD
Emergency Medicine Specialist
Mount Nittany Medical Center, United States
Disclosure information not submitted.
Brian Newcomb, MD
Medical Director, Emergency Department
Mount Nittany Medical Center, United States
Disclosure information not submitted.
Title: Improving Sepsis Care in the Emergency Department at a Community Hospital
Introduction: Sepsis is one of the leading causes of death in hospitals and rapid diagnosis and treatment is imperative in preventing mortality. Sepsis is a Centers for Medicare and Medicaid Services core measure that uses 3 and 6 hour bundles to promote appropriate care and early goal directed therapy. Ensuring best practices and core measure compliance can be challenging in the community hospital setting with limited resources. Upon review, there is little available literature to guide smaller community hospitalists on how to operationalize these best practices. The purpose of this taskforce was to develop strategies to increase the SEP-1 core measure compliance and improve sepsis care.
Methods: This was a single center, retrospective, quasi-experimental study comparing core measure compliance before and after intervention. The task force was made up of a multidisciplinary team of key stakeholders. The following interventions were implemented: Revision of ED sepsis screening criteria, order set optimization, use of prehospital fluids and IBW for fluid bolus, educational programming, revision of sepsis alert, and an ED Pharmacist sepsis initiative. Some order set revisions include appropriate broad spectrum antibiotics, reflex repeat lactic acid order, and weight based fluid orders with automatic nursing assessment. The new screening criteria combined both qSOFA and SIRS components to improve sensitivity. Sepsis abstractors were consulted to optimize provider documentation, focusing on utilization of IBW and prehospital fluids.
Results: There were 715 sepsis cases included in this analysis with 383 cases in the pre-intervention group and 332 cases in the post-intervention group. Since implementation of these interventions, overall SEP-1 compliance increased by 13% (p < 0.05). Individual bundle components improved for the following: initial lactate (12.7% vs 9%, p = 0.32), repeat lactic acid (26.1% vs 5%, p < 0.001), broad spectrum antibiotics (28.1% vs 14%, p < 0.05), and blood culture obtainment (27.6% vs 14%, p < 0.05). Sepsis order set usage increased by 100%. More SEP-1 compliant patients screened positive at triage with the new criteria (69% vs 39%, p=0.019).
Conclusion: In conclusion, there are many actions that can be taken to improve sepsis care at the community hospital level.