Title: Initiation of a Sepsis Alert Team to Enhance 3-hour and 6-hour Sepsis Bundle Compliance
Introduction/Hypothesis: Sepsis and septic shock continue to be challenging burdens on healthcare systems, associated with high overall mortality and cost. High rates of compliance with 3-hour and 6-hour sepsis bundles have demonstrated significant reductions in inpatient mortality. The goal of our study is to describe an approach of implementing a hospital-wide sepsis alert team (SAT) for improved overall sepsis bundle compliance.
Methods : We conducted a retrospective analysis of severe sepsis and septic shock at our community teaching hospital from 2017 to 2020, before and after the initiation of the SAT.
The SAT consisted of APRNs, working under the supervision of an Intensivist, trained to implement a Sepsis protocol addressing 3-hour and 6-hour sepsis bundles. Additionally, education on assessment and recognition of sepsis and septic shock was provided to nursing staff for ED and stepdown services. ED and Hospitalist physicians were also trained on when to call upon the SAT.
The SAT was implemented September 2018. A sepsis committee consisting of representatives from Critical Care, ED and Hospitalist physician groups, nursing staff, radiology, laboratory, pharmacy, etc. convened on a monthly basis to review sepsis bundle compliance rates and provide ongoing feedback for improvement. Year-end compliance rates for 3-hour and 6-hour sepsis bundles were measured for 2017 to 2020.
Results: Year-end 3-hour compliance for severe sepsis was 53.8%, 61.5%, 76.9%, and 80.3% for 2017, 2018, 2019 and 2020 respectively. Year-end 3-hour compliance for septic shock was 67.6%, 62.5%, 81.4%, and 81.8% for 2017, 2018, 2019 and 2020 respectively. Year-end 6-hour compliance for severe sepsis was 47.9%, 63.6%, 86.1%, and 89.3% for 2017, 2018, 2019 and 2020 respectively. Finally, year-end 6-hour compliance for septic shock was 27.3%, 80.8%, 86.1%, and 91.9% for 2017, 2018, 2019 and 2020 respectively.
Conclusion: We demonstrate that implementing a hospital wide SAT for improved detection and response to sepsis and septic shock is achievable. Moreover, we show that initiating a SAT can drastically improve overall compliance with 3-hour and 6-hour sepsis bundles. Strategies such as these will ultimately have a positive downstream effect of lower morbidity, mortality and overall healthcare costs associated with sepsis and septic shock.