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Sepsis is a leading cause of death, but evidence suggests that early recognition and prompt intervention can save lives. In 2005 Houston Methodist Hospital prioritized sepsis detection and management in its ICU. In late 2007, because of marginal effects on sepsis death rates, the focus shifted to designing a program that would be readily used by nurses and ensure early recognition of patients showing signs suspicious for sepsis, as well as the institution of prompt, evidence-based interventions to diagnose and treat it.The intervention had four components: organizational commitment and data-based leadership; development and integration of an early sepsis screening tool into the electronic health record; creation of screening and response protocols; and education and training of nurses. Twice-daily screening of patients on targeted units was conducted by bedside nurses; nurse practitioners initiated definitive treatment as indicated. Evaluation focused on extent of implementation, trends in inpatient mortality, and, for Medicare beneficiaries, a before-after (2008-2011) comparison of outcomes and costs. A federal grant in 2012 enabled expansion of the program.By year 3 (2011) 33% of inpatients were screened (56,190 screens in 9,718 unique patients), up from 10% in year 1 (2009). Inpatient sepsis-associated death rates decreased from 29.7% in the preimplementation period (2006-2008) to 21.1% after implementation (2009-2014). Death rates and hospital costs for Medicare beneficiaries decreased from preimplementation levels without a compensatory increase in discharges to postacute care.This program has been associated with lower inpatient death rates and costs. Further testing of the robustness and exportability of the program is under way.

Original publication

DOI

10.1016/s1553-7250(15)41063-3

Type

Journal article

Journal

Joint Commission journal on quality and patient safety

Publication Date

11/2015

Volume

41

Pages

483 - 491

Addresses

Sepsis Early Recognition and Response Initiative, Department of Surgery, Houston Methodist Hospital, USA.

Keywords

Humans, Sepsis, Hospital Mortality, Intensive Care Units, Cost Savings, Health Care Costs, Organizational Innovation, Organizational Objectives, Nursing Assessment, Quality Assurance, Health Care, Texas, Electronic Health Records, Quality Improvement, Patient Safety