Reductions in Sepsis Mortality and Costs After Design and Implementation of a Nurse-Based Early Recognition and Response Program.
BACKGROUND
Sepsis is a leading cause of death, but evidence suggests that early recognition and prompt intervention can save lives. In 2005 Houston Methodist Hospital prioritized sepsis detection and management in its ICU. In late 2007, because of marginal effects on sepsis death rates, the focus shifted to designing a program that would be readily used by nurses and ensure early recognition of patients showing signs suspicious for sepsis, as well as the institution of prompt, evidence-based interventions to diagnose and treat it.


METHODS
The intervention had four components: organizational commitment and data-based leadership; development and integration of an early sepsis screening tool into the electronic health record; creation of screening and response protocols; and education and training of nurses. Twice-daily screening of patients on targeted units was conducted by bedside nurses; nurse practitioners initiated definitive treatment as indicated. Evaluation focused on extent of implementation, trends in inpatient mortality, and, for Medicare beneficiaries, a before-after (2008-2011) comparison of outcomes and costs. A federal grant in 2012 enabled expansion of the program.


RESULTS
By year 3 (2011) 33% of inpatients were screened (56,190 screens in 9,718 unique patients), up from 10% in year 1 (2009). Inpatient sepsis-associated death rates decreased from 29.7% in the preimplementation period (2006-2008) to 21.1% after implementation (2009-2014). Death rates and hospital costs for Medicare beneficiaries decreased from preimplementation levels without a compensatory increase in discharges to postacute care.


CONCLUSIONS
This program has been associated with lower inpatient death rates and costs. Further testing of the robustness and exportability of the program is under way.
Sepsis Early Recognition and Response Initiative, Department of Surgery, Houston Methodist Hospital, USA.
Stephen L
SL
Jones
Carol M
CM
Ashton
Lisa
L
Kiehne
Elizabeth
E
Gigliotti
Charyl
C
Bell-Gordon
Maureen
M
Disbot
Faisal
F
Masud
Beverly A
BA
Shirkey
Nelda P
NP
Wray
D017046:Cost Savings; D057286:Electronic Health Records; D017048:Health Care Costs; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D009730:Nursing Assessment; D009936:Organizational Innovation; D009937:Organizational Objectives; D061214:Patient Safety; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D018805:Sepsis / Q000191:economics* / Q000401:mortality* / Q000451:nursing*; D013781:Texas / Q000453:epidemiology