Improving care of the sepsis patient.
BACKGROUND
In 2004, Christiana Care Health System (Christiana Care), a 1,100-bed tertiary care facility, used the Surviving Sepsis Campaign guidelines as the foundation for an independent initiative to reduce the mortality rate by at least 25%.


METHODS
In 2004, an interdisciplinary sepsis team developed a process for rapidly recognizing at-risk patients; evaluating a patient's clinical status; and providing appropriate, timely therapy in three major areas of sepsis care; recognition of the sepsis patient, resuscitation priorities, and intensive care management. The Sepsis Alert program, which did not require additional staffing, was developed and implemented in 10 months. The Sepsis Alert packet included a care management guideline, a treatment algorithm, an emergency department treatment order set, and multiple adjuncts to streamline patient identification and management.


RESULTS
Introduction of sepsis resuscitation and critical care management standards led to a 49.4% decrease in mortality rates (p < .0001), a 34.0% decrease in average length of hospital stay (p < .0002), and a 188.2% increase in the proportion of patients discharged to home (p < .0001) when the historic control group is compared with the postimplementation group from January 2005 through December 2007.


CONCLUSIONS
An integrated leadership team, using existing resources, transformed frontline clinical practice by providers from multiple disciplines to reduce mortality in the population of patients with sepsis.
Zubrow
Marc T
MT
Christiana Care Health Services, Newark, Delaware, USA. mzubrow@christianacare.org
Sweeney
Thomas A
TA
Fulda
Gerard J
GJ
Seckel
Maureen A
MA
Ellicott
Alison C
AC
Mahoney
Donna D
DD
Fasano-Piectrazak
Paula M
PM
Farraj
Megan B
MB
D001363:Awards and Prizes; D002985:Clinical Protocols; D003422:Critical Care / Q000458:organization & administration; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008873:Mid-Atlantic Region; D009096:Multi-Institutional Systems; D019982:Organizational Case Studies; D011787:Quality of Health Care; D018805:Sepsis / Q000401:mortality*