Using the EBP Sepsis Bundle to Decrease ED Mortality
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Session F presented Friday, September 15, 2017
Purpose: Sepsis is the leading cause of death in non-coronary intensive care units and the tenth leading cause of death in the United States overall. One in one-hundred eighty five Americans were expected to be hospitalized in 2015 with sepsis. Sepsis is the most costly inpatient hospital condition with annual cost in 2011 estimated at 23.3 billion dollars. The ED has the opportunity to impact sepsis care as 57% of the patients are admitted in our ED. Timely treatment is critical. The purpose of this project, as challenged by The Ohio Hospital Association, was to decrease the incidence and mortality of Sepsis by 30 percent over a 2 year period.
Design: This quality improvement project included formation of a multidisciplinary team. Initial hospital base line data was collected and education deployed to include a sepsis triage protocol, and the three and six hour sepsis bundle. A sepsis checklist was developed and deployed to increase bundle compliance.
Setting: The project was conducted at a rural 232 bed acute care, nonprofit, teaching hospital in southern Ohio with a 43 bed emergency department that has an annual volume of 50,000 ED patient visits.
Participants/Subjects: The study population for the project was all patients treated in the ED and admitted with severe sepsis and septic shock.
Methods: The sepsis triage screening tool and the sepsis checklist were used to increase compliance with patient identification and early goal directed bundle compliance. The checklist provided reminders for the staff on the primary gaps identified in the three hour bundle elements of crystalloid fluid calculations and repeat lactate levels.
Results/Outcomes: The initial base line data was a review of cases from January through June 2015 and the overall three hour bundle compliance was at 52 %. Mortality was 15%. From July 2015 to July 2016, the sepsis three hour bundle compliance increased to 94%. The mortality decreased to 10%. The statewide initiative continues within Ohio, with only a 9% reduction in mortality. The project continues until July 2017.
Implications: A program using the EBP sepsis bundle can improve patient care and decrease patient mortality. On-going nurse and provider education supported by a multidisciplinary team with ED and inpatient collaboration is critical for accomplishing sepsis care.