title: Kaiser Permanente's performance improvement system, part 3: multisite improvements in care for patients with sepsis.
abstract: BACKGROUND
  In 2008, Kaiser Permanente Northern California implemented an initiative to improve sepsis care. Early detection and expedited implementation of sepsis treatment bundles that include early goal-directed therapy (EGDT) for patients with severe sepsis were implemented.
  
  
  METHODS
  In a top-down, bottom-up approach to performance improvement, teams at 21 medical centers independently decided how to implement treatment bundles, using a "playbook" developed by rapid cycle pilot testing at two sites and endorsed by a sepsis steering committee of regional and medical center clinical leaders. The playbook contained treatment algorithms, standardized order sets and flow charts, best practice alerts, and chart abstraction tools. Regional mentors and improvement advisers within the medical centers supported team-building and rapid implementation. Timely and actionable data allowed ongoing identification of improvement opportunities. A consistent approach to performance improvement propelled local rapid improvement cycles and joint problem solving across facilities.
  
  
  RESULTS
  The number of sepsis diagnoses per 1,000 admissions increased from a baseline value of 35.7 in July 2009 to 119.4 in May 2011. The percent of admitted patients who have blood cultures drawn who also have a serum lactate level drawn increased from a baseline of 27% to 97% in May 2011. The percent of patients receiving EGDT who had a second and lower lactate level within six hours increased from 52% at baseline to 92% in May 2011.
  
  
  CONCLUSIONS
  Twenty-one cross-functional frontline teams redesigned processes of care to provide regionally standardized, evidence-based treatment algorithms for sepsis, substantially increasing the identification and risk stratification of patients with suspected sepsis and the provision of a sepsis care bundle that included EGDT.
authors: The Permanente Medical Group, Oakland, California, USA. alan.whippy@kp.org
authors: Alan
authors: A
authors: Whippy
authors: Melinda
authors: M
authors: Skeath
authors: Barbara
authors: B
authors: Crawford
authors: Carmen
authors: C
authors: Adams
authors: Gregory
authors: G
authors: Marelich
authors: Mezhgan
authors: M
authors: Alamshahi
authors: Josefina
authors: J
authors: Borbon
mesh_terms: D000465:Algorithms; D002140:California / Q000453:epidemiology; D019091:Critical Pathways / Q000592:standards; D042241:Early Diagnosis; D057286:Electronic Health Records / Q000592:standards* / Q000639:trends; D055317:Evidence-Based Practice; D006279:Health Maintenance Organizations / Q000592:standards* / Q000639:trends; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards*; D019984:Quality Indicators, Health Care; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*