Collaboration Between Two Hospital Departments to Improve Care of the Septic Patient

Purpose:
The presentation will discuss the collaborative methods used by two hospital departments to decrease patient mortality, hospital length of stay, and hospital costs for patients admitted to the Intensive Care Unit (ICU) with the diagnosis of sepsis.

Significance:
Decreased hospital lengths of stay and decreased hospital costs have been proven when a sepsis protocol is the gold standard of practice. Through collaboration with the Emergency Department(ED) the ICU nursing staff were able to further improve the quality of care for septic patients.

Strategy and Implementation:
Since the sepsis protocol was instituted in late 2007, the ICU has seen a decrease in hospital lengths of stay by two days which resulted in a cost savings of approximately $6,000.00 per patient. The decision was made to combine ICU admission and sepsis protocol orders into one form to ensure use of the protocol since a number of patients admitted with sepsis were not placed on the protocol. A collaborative process with the ED was developed for early identification and treatment of sepsis. An ED nurse triage form was designed to identify a septic patient and to include nursing interventions. An ED physician triage form was developed to include additional criteria for identification of sepsis, early initiation of antibiotics, and activiation of the sepsis alert. Since initial sepsis treatment was implementated in the ED, patients received the first dose of antibiotics before transfer to the ICU. Preliminary data demonstrated improved patient outcomes and decreased hospital stays.

Evaluation:
Identification of sepsis and beginning the sepsis prootocol in the ED is imperative for quality patient outcomes. Collaboration between the ED and the ICU contributed to a decrease in hospital lengths of stay from 12.3 days to 10.3 days and a decrease in patient mortality from 51% to 42%.

Implications for Practice:
Patient mortality, hospital costs and hospital lengths of stay decrease when hospital departments collaborate to begin timely identification and treatment of patients with sepsis.