title: Standardizing sepsis screening and management via a tele-ICU program improves patient care.
abstract: OBJECTIVE
  This article evaluates the feasibility of a tele-intensive care unit (ICU) nurse-driven early identification and treatment process for severe sepsis patients in improving compliance to evidence-based practice.
  
  
  METHODS
  Florence Nightingale identified that by using science, logic, and compassion to manipulate the patient care environment nurses could create the best possible conditions for healing to occur. Nurses in a tele-ICU used this premise to initiate a standardized screening and data collection program using a custom-built document sharing application that conformed to the Surviving Sepsis Campaign (SSC) criteria for identification and treatment of severe sepsis.
  
  
  RESULTS
  The tele-ICU nurses performed 89,921 screens on 36,353 ICU admissions to 161 ICU beds across a geographical range of 500 miles. Between January 1, 2006 and December 31, 2008, tele-ICU nurses identified 5,437 patients as meeting the criteria for severe sepsis. Statistically significant increases in compliance with SSC's bundled care recommendations were realized during this study period with four initial elements: antibiotic administration increased from 55% in 2006 to 74% in 2008 (p=0.001), serum lactate measurement increased from 50% to 66% (p=0.001), the initial fluid bolus of ≥ 20 mL/kg increased from 23% to 70% (p=0.001), and central line placement increased from 33% to 50% (p=0.001).
  
  
  CONCLUSIONS
  A tele-ICU nurse-driven process can prompt earlier identification and improve compliance to evidence-based practice bundles for complex disease states such as severe sepsis.
authors: Sutter Health, eICU, Sacramento, California 95816, USA. rincont@sutterhealth.org
authors: Teresa A
authors: TA
authors: Rincon
authors: Grace
authors: G
authors: Bourke
authors: Adam
authors: A
authors: Seiver
mesh_terms: D002140:California; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008403:Mass Screening / Q000592:standards; D024802:Nurse's Role; D017410:Practice Guidelines as Topic; D019114:Remote Consultation; D018805:Sepsis / Q000175:diagnosis* / Q000628:therapy*; D017216:Telemedicine