Implementation of a multicenter performance improvement program for early detection and treatment of severe sepsis in general medical-surgical wards.
Sepsis is a leading cause of in-hospital death, and evidence suggests a higher mortality in patients presenting with sepsis on the ward compared to those presenting to the emergency department. Ward patients who develop severe sepsis may have poor outcomes for a variety of reasons, including delayed diagnosis, lack of readily available staffing, and delayed treatment. We report on a multihospital quality improvement program for early detection and treatment of sepsis on general medical-surgical wards. We describe a multipronged approach to improve severe sepsis outcomes using the Institute for Healthcare Improvement's Plan-Do-Study-Act model. Sixty sites engaged in a collaborative implementation process that aligned people, process, and technology. Based on our experience, we recommend a stepwise approach to implement such a program: (1) both administrative and clinical leadership commit to a common goal; (2) appoint clinical champions and give them authority to engage other clinicians to improve timeliness of interventions; (3) map workflows and processes to rely heavily on the nursing staff's ability to evaluate and report severe sepsis screening results; (4) if available, design and deploy technology with the assistance of clinical informaticians (eg, to enable electronic health records-based continuous screening); (5) to determine success, consider tracking screening compliance and process, and outcome measures such as length of stay and mortality. Journal of Hospital Medicine 2016;S11:32-S39. © 2016 Society of Hospital Medicine.
Cooper Research Institute-Critical Care, Cooper University Hospital, Camden, New Jersey. schorr-christa@cooperhealth.edu.
Christa
C
Schorr
Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri.
Andrew
A
Odden
Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, New York.
Laura
L
Evans
Systems Research Initiative, Kaiser Permanente Division of Research, Kaiser Permanente, Oakland, California.
Gabriel J
GJ
Escobar
Division of Hospital Medicine, Medical Informatics and Care Delivery Innovation, Cooper University Hospital, Camden, New Jersey.
Snehal
S
Gandhi
Department of Quality and Safety, California Pacific Medical Center, San Francisco, California.
Sean
S
Townsend
Department of Pulmonary, Critical Care, and Sleep Medicine, Rhode Island Hospital, Providence, Rhode Island.
Mitchell
M
Levy
D042241:Early Diagnosis; D019983:Guideline Adherence; D017052:Hospital Mortality; D006757:Hospital Units; D006801:Humans; D015337:Multicenter Studies as Topic; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement; D018805:Sepsis / Q000175:diagnosis / Q000628:therapy*; D012720:Severity of Illness Index