The adoption of an EMR-based screening tool and a sepsis treatment bundle drove down mortality rates markedly over four years.
A sepsis surveillance and treatment initiative at Frederick Memorial Hospital has slashed the facility's mortality rate for the deadly infection.
On an annual basis, sepsis affects about 1.7 million American adults and the infection is linked to more than 250,000 deaths.
From 2012 to 2016, Frederick Memorial Hospital implemented sepsis surveillance and treatment measures that reduced the infection's mortality rate by 65%.
"In 2012, we recognized that our mortality level was one-and-a-half times what the expected values were based on coding and auditing of charts, and patient comorbidities. So, we started to drill in on the root causes. What we found was that we did not have good bundles or processes that were in place to even identify patients who were at risk of sepsis," says Debra O'Connell, RN, manager of performance improvement at the Frederick, Maryland-based facility.
Screening tool adoption
Frederick Memorial's first step toward addressing its sepsis challenge was developing an EMR-based screening tool.
"There is a screen shot that provides the clinical staff and the nurses with some fundamental questions about the patient's status. It asks about vital signs, it asks about whether there are potential sources of infection, it asks about mental status changes, it asks about white blood cell levels—it asks questions and the nurses fill in the blanks. Then the tool calculates a score, and if patients have a score above a value of 2, it prompts the nurse to get additional orders from the physician because the patient may have sepsis," O'Connell says.
The screening tool underwent a clinical trial at Frederick Memorial, then it was implemented in the emergency department and as an as-needed tool associated with specific chief complaints, she says.
"If a patient came into the emergency department complaining about frequent urination and it could have been a potential urinary tract infection, the nurses could implement our sepsis detection tool. If the tool indicated the patient could be septic, we would implement the appropriate interventions. We would implement the bundle that is now known as the Sepsis Core Measure."
The next step was to make the screening tool available to clinicians and nurses throughout the hospital, O'Connell says. "After we implemented the tool in the emergency room, nurses on the medical floors and the intensive care unit could use it as a screening tool if they were suspicious that a patient could be septic."
In 2017, Frederick Memorial started using the screening tool for active surveillance of all inpatients.
"We recognized there were some opportunities to revise the screening tool and change it from an ED screening tool to more of a sepsis surveillance screening tool, so that all patients who were admitted to the hospital would be screened on admission, then two times per day after admission. That allows us to capture patients who may be hovering with sepsis," she says.
Some members of the nursing staff initially resisted the daily screening of all inpatients, but the reduced mortality rate played a decisive role in achieving widespread adoption of the surveillance effort, O'Connell says.
"We don't want to miss opportunities to capture sepsis because it is a severe disease process. You can go downhill very quickly; and once that process starts to progress, if the appropriate actions are not in place patients can progress into septic shock and die. That is the point of trying to capture sepsis by screening two times a day."
2 keys to success
O'Connell says there were two essential elements in Frederick Memorial's successful sepsis prevention initiative.
- Physician champion leadership: "The biggest thing is finding some physician champions who can help drive the processes, the culture change, and education of the entire staff. We had a physician leader in our organization who helped drive this initiative and who helped educate our providers."
- Sharing the data: "The other piece is showing the outcomes—being transparent with information. Once we were able to demonstrate that there were benefits from the screening tool, identifying septic patients, and that our treatments were decreasing mortality rates, that made a big difference with our staff."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Sepsis is a leading cause of death in the United States.
Early detection of sepsis in hospitals is crucial to reducing mortality rates.
Initiatives to transform a hospital's approach to sepsis take significant time and effort.