title: Clinical and economic impact of a quality improvement initiative to enhance early recognition and treatment of sepsis.
abstract: BACKGROUND
  Studies evaluating the clinical effectiveness of sepsis screening tools and methods to improve the time from diagnosis to antibiotic administration are needed to improve sepsis-related outcomes.
  
  
  OBJECTIVE
  To evaluate the clinical and economic impact of a sepsis quality improvement initiative to improve early recognition and treatment of sepsis.
  
  
  METHODS
  A retrospective observational study of adults with sepsis was performed in a 433-bed tertiary medical center. Baseline data were collected for 181 patients with sepsis diagnosis-related group (DRG) coding assignments from July through September 2013. The intervnetion group included 216 patients from October through December 2013. A First-Dose STAT Antibiotic policy was developed, and nurses were instructed to complete an electronic sepsis screening tool once per shift. Primary outcomes included in-hospital mortality and intensive care unit (ICU) length of stay (LOS). Secondary outcomes included overall LOS and cost per case.
  
  
  RESULTS
  Nonsignificant decreases in overall LOS (7.43 ± 5.68 days vs 6.77 ± 5 days; P = 0.138) and in-hospital mortality (13.8% vs 8.8%; P = 0.113) were observed in patients with sepsis DRGs. Early recognition and treatment contributed to significant reductions in ICU LOS (5.85 ± 4.38 days vs 4.21 ± 3.64 days; P = 0.003) and total cost per case ($14 378 vs $12 311; P = 0.033). The percentage of highest disease-severity DRG coding assignments decreased from 7.9% to 0%.
  
  
  CONCLUSIONS
  Strategies to improve early recognition and treatment of sepsis, including routine use of an electronic sepsis screening tool and implementation of a First-Dose STAT Antibiotic policy, contributed to significant reductions in ICU LOS and cost per case.
authors: Saint Joseph Hospital, Lexington, KY, USA juddwr@sjhlex.org.
authors: William R
authors: WR
authors: Judd
authors: Saint Joseph Hospital, Lexington, KY, USA.
authors: Dana M
authors: DM
authors: Stephens
authors: Saint Joseph Hospital, Lexington, KY, USA.
authors: Charles A
authors: CA
authors: Kennedy
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D017046:Cost Savings; D003953:Diagnosis-Related Groups; D006745:Hospital Bed Capacity, 300 to 499; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D058996:Quality Improvement; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy* / Q000191:economics; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotics; clinical practice guidelines; cost-containment; infectious disease; sepsis