System-wide Leadership on Achieving Better Clinical Outcomes in Severe Sepsis and Septic Shock

Purpose:
Severe sepsis is often identified through manual nursing screenings in the ED and critical care areas, potentially missing up to 40% of cases during the early, most treatable stages of the sepsis cascade. An electronic sepsis alert provides continual surveillance yielding strong improved outcomes.

Significance:
Severe sepsis affects 750,000 people annually and is the leading cause of death in critical care units. Because the most effective intervention starts within six hours of symptom onset, early diagnosis is crucial. The early signs of sepsis, common in less serious illnesses, are too often minimized.

Strategy and Implementation:
Costs of treating severe sepsis can vary widely with early diagnosis and prompt, evidence-based interventions can bring a shorter length of stay, lower mortality, and reduced risk and complications from missed or delay diagnoses. Plus, diagnostic errors are the leading cause of medical malpractice and account for twice the number of settled claims as medication mistakes. To address the growing incident of severe sepsis we implemented an electronic surveillance algorithm to assess for developing sepsis each time a new lab value or vital sign posts to the patient record. If two signs of systemic inflammation, like rapid breathing or heart rate, and at least one lab value signaling new onset organ dysfunction are identified, a nurse is alerted by pager to immediately assess the patient for severe sepsis. Beyond improved outcomes, this solution has introduced a new model of just-in-time knowledge to effectively transition evidence-based best practices to consistent clinical practice.

Evaluation:
Length of stay for sepsis patients was reduced by 21.6%, mortality reduced by 14%, and 25% increase in patients being discharged home. Further, savings of over $1M were realized because of reduced ALOS and increased severity index through more appropriate documentation.

Implications for Practice:
Activity lists in the electronic medical record have shifted nursing practice to a task-oriented approach to care, often leaving gaps in seeing a full clinical picture. Turning the huge volume of EMR data into useful clinical information can improve financial, clinical, and patient safety outcomes.