Early Sepsis Identification at the point of Triage

Purpose:
Decreasing sepsis mortality requires a team approach. After evaluation of the sepsis process at this hospital, we created a sepsis plan to improve sepsis outcomes including mortality. Improving ED triage and patient placement through early identification were essential to our new process.

Significance:
Sepsis is the 10th leading cause of death in the United States. Nationally, patients with septic shock have a 46% mortality rate. At this Magnet facility, our mortality rate is 22% with a 4.8% deviation from expected mortality.

Strategy and Implementation:
A nurse and physician, co-led interdisciplinary team developed a sepsis plan based upon the Surviving Sepsis Campaign guidelines. The plan includes a triage sepsis assessment performed upon arrival to the ED and 2 hours later. This assessment is completed electronically and creates a computerized alert identifing the patient as “possible sepsis” based on vital sign and laboratory criteria. The alert is a "bug" which appears on the ED screen identifying the patient as possible sepsis which promotes early treatment. This 2-level triage guides patient care in the ED and ensures the patient is placed in the appropriate care area for treatment. Sepsis protocols and inpatient orders were also developed to create consistent treatment practices. Nurses are the driving force behind early symptom recognition and are essential for implementation of the orders and evaluation of the treatment.

Evaluation:
Sepsis-related emergent transfers to the ICU decreased from three patients per month to zero for six consecutive months. The implementation of consistent blood cultures and antibiotics for patients with suspected sepsis each rose from 60% to 100% and has been maintained for six months.

Implications for Practice:
Creating electronic triggers leads to early identification and appropriate triage and treating of the septic patient.