Implementation of the Surviving Sepsis Campaign one-hour bundle in a short stay unit: A quality improvement project

Gripp, Lauren; Raffoul, Melanie; Milner, Kerry A.

doi:10.1016/j.iccn.2020.103004

Cited by 13 publications

(23 citation statements)

References 19 publications

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“…Sepsis is featured by fuzzy symptomatology and limited clinical manifestations in the initial stages, making its rapid detection a challenge for the EMS personnel [ 71 ]. Late recognition frequently implies that its diagnosis is often accompanied with syndromes of multiorgan dysfunction already established, delaying the therapeutic measures [ 72 , 73 ].…”

Section: Discussionmentioning

confidence: 99%

Combination of Prehospital NT-proBNP with qSOFA and NEWS to Predict Sepsis and Sepsis-Related Mortality

et al. 2022

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Background. The aim of this study was to assess the role of prehospital point-of-care N-terminal probrain natriuretic peptide to predict sepsis, septic shock, or in-hospital sepsis-related mortality. Methods. A prospective, emergency medical service-delivered, prognostic, cohort study of adults evacuated by ambulance and admitted to emergency department between January 2020 and May 2021. The discriminative power of the predictive variable was assessed through a prediction model trained using the derivation cohort and evaluated by the area under the curve of the receiver operating characteristic on the validation cohort. Results. A total of 1,360 patients were enrolled with medical disease in the study. The occurrence of sepsis, septic shock, and in-hospital sepsis-related mortality was 6.4% (67 cases), 4.2% (44 cases), and 6.1% (64 cases). Prehospital National Early Warning Score 2 had superior predictive validity than quick Sequential Organ Failure Assessment and N-terminal probrain natriuretic peptide for detecting sepsis and septic shock, but N-terminal probrain natriuretic peptide outperformed both scores in in-hospital sepsis-related mortality estimation. Application of N-terminal probrain natriuretic peptide to subgroups of the other two scores improved the identification of sepsis, septic shock, and sepsis-related mortality in the group of patients with low-risk scoring. Conclusions. The incorporation of N-terminal probrain natriuretic peptide in prehospital care combined with already existing scores could improve the identification of sepsis, septic shock, and sepsis-related mortality.

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Section: Discussionmentioning

confidence: 99%

Combination of Prehospital NT-proBNP with qSOFA and NEWS to Predict Sepsis and Sepsis-Related Mortality

et al. 2022

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“…Severe sepsis clinical criteria were met while in the ED for 51,701 (20%) of all admissions and 20,736 (53%) of sepsis admissions meeting basic inclusion criteria. Finally, 35,847 (69%) of these patients were also treated with broad-spectrum antibiotics and IV fluids during hospitalization, including 19,675 (95%) with sepsis discharge diagnosis. The final study population therefore represents 10% of all 2016-17 adult hospital admissions and 47% of sepsis admissions.…”

Section: Resultsmentioning

confidence: 99%

Impact of Sepsis Identification and Treatment Time on In-Hospital Mortality, Length of Stay, and Hours in the Intensive Care Unit

2021

Preprint

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Objective: The objective of this study was to examine the impact of timely treatment and identification of sepsis on patient outcomes at Sutter Health, a mixed-payer healthcare system in northern California, US. Methods: This observational, retrospective analysis considered electronic health record (EHR) data for individuals who presented with sepsis during 2016-17 at any of Sutter Health's 22 emergency departments (ED). Impacts were assessed for the timing of broad-spectrum antibiotic and intravenous (IV) fluid initiation, first vital signs, sepsis screening, and lactate results. Outcomes were in-hospital mortality, hospital length of stay (LOS) and intensive care unit (ICU) hours for patients discharged alive. Results: The final sample size was 35,847 (N=9,638 severe sepsis, N=5,309 septic shock). Early fluid initiation had the largest estimated impacts: a mortality reduction of 2.85%[2.03%,3.68%] overall and 2.94%[1.44%,4.48%] for severe sepsis (within 1 hour of sepsis presentation), and 14.66%[9.23%,20.07%] for septic shock (within 3 hours); reduced LOS (days) 1.39[1.08,1.71] overall, 2.30[1.31,3.21] severe sepsis, 3.07[1.21,4.94] septic shock; and fewer ICU hours 25.93[16.95,34.66] overall, 35.06[14.7,56.99] severe sepsis, 41.99[15.70,70.68] septic shock (within 3 hours). Sepsis screening within 30 minutes was also associated with mortality reductions (3.88%[2.96%,4.90%] overall, 1.74%[0.08%,3.50%] severe sepsis, 6.78%[3.12%,10.33%] septic shock). The greatest improvement opportunity was estimated for joint initiation of antibiotics and IV fluids, with a modest additional mortality reduction of 0.80%[0.47%,1.17%] overall, 0.77%[0.34%,1.19%] severe sepsis, 2.94%[1.83%,3.97%] septic shock; LOS reduction of 0.37[0.28,0.46] overall, 0.29[0.17,0.43] severe sepsis, 0.25[0.01,0.51] septic shock (within 1 hour); ICU hours reduction of 4.85[3.26,6.57] overall, 5.07[2.55,7.67] severe sepsis, 3.85[1.69,6.24] septic shock (within 3 hours).

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“…It has been reported that nurse-physician communication and collaboration are necessary components to improve sepsis care. 18 Research suggests that nurse-physician communication was associated with a 4% decrease in the likelihood that patients would develop catheter-associated sepsis. 34 Differences in the association between nurse and physician staffing have also been reported, in which each additional step-down patient per nurse was associated with a 0.53 increase in sepsis.…”

Section: Discussionmentioning

confidence: 99%

“…20 Some have identified the workload of nurses as the primary mechanism that prevents the rapid initiation of antibiotic treatment to patients with a diagnosis of sepsis 21 and that an adequate number of nurses are necessary to improve SEP-1 bundle compliance. 18 In recent work, we found that nurse staffing was associated with 60-day mortality in patients with sepsis in hospitals across New York State. 22 In the current study, we examined a nationwide sample of hospitals and Medicare beneficiaries with a diagnosis of sepsis to estimate the association between the hours of care provided by registered nurses and 60-day mortality and project the number of lives that could be saved by increasing the number of hours of nursing care.…”

Section: Introductionmentioning

confidence: 93%

“…Although the benefit of nurse-driven sepsis treatment tools has been reported, [13][14][15][16][17] it is nurse-physician communication that has been identified as a necessary component to support the improvement that is needed in sepsis care. 18 To be compliant with the SEP-1 early management bundle, all bundle components must be implemented within 3 hours in the presence of a systemic inflammatory response (temperature of >101°F or <96.8°F, heart rate >90 beats/minute, respirations >20 breaths/minute, and white blood cell count of >12 000 or <4000/μL, or >10% bandemia) or a diagnosis of suspected severe sepsis or septic shock. These components include not only serum lactate levels and blood cultures, but also antibiotics and crystalloid fluids.…”

Section: Introductionmentioning

confidence: 99%

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Association of Registered Nurse Staffing With Mortality Risk of Medicare Beneficiaries Hospitalized With Sepsis

Cimiotti

Becker

et al. 2022

JAMA Health Forum

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IMPORTANCESepsis is a major physiologic response to infection that if not managed properly can lead to multiorgan failure and death. The US Centers for Medicare & Medicaid Services (CMS) requires that hospitals collect data on core sepsis measure Severe Sepsis and Septic Shock Management Bundle (SEP-1) in an effort to promote the early recognition and treatment of sepsis.Despite implementation of the SEP-1 measure, sepsis-related mortality continues to challenge acute care hospitals nationwide. OBJECTIVE To determine if registered nurse workload was associated with mortality in Medicare beneficiaries admitted to an acute care hospital with sepsis. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study used 2018 data from the American Hospital Association Annual Survey, CMS Hospital Compare, and Medicare claims on Medicare beneficiaries age 65 to 99 years with a primary diagnosis of sepsis that was present on admission to 1 of 1958 nonfederal, general acute care hospitals that had data on CMS SEP-1 scores and registered nurse workload (indicated by registered nurse hours per patient day [HPPD]). Patients with sepsis were identified based on 29 International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. Data were analyzed throughout 2021. EXPOSURES SEP-1 score and registered nurse staffing. MAIN OUTCOMES AND MEASURESThe patient outcome of interest was mortality within 60 days of admission. Hospital characteristics included number of beds, ownership, teaching status, technology status, rurality, and region. Patient characteristics included age, sex, transfer status, intensive care unit admission, palliative care, do-not-resuscitate order, and a series of 29 comorbid diseases based on the Elixhauser Comorbidity Index. RESULTSIn total, 702 140 Medicare beneficiaries (mean [SD] age, 78.2 [8.7] years; 360 804 women [51%]) had a diagnosis of sepsis. The mean SEP-1 score was 56.1, and registered nurse HPPD was 6.2. In a multivariable regression model, each additional registered nurse HPPD was associated with a 3% decrease in the odds of 60-day mortality (odds ratio, 0.97; 95% CI 0.96-0.99) controlling for SEP-1 score and hospital and patient characteristics. CONCLUSIONS AND RELEVANCEThe results of this cross-sectional study suggest that hospitals that provide more registered nurse hours of care could likely improve SEP-1 bundle compliance and decrease the likelihood of mortality in Medicare beneficiaries with sepsis.

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Implementation of the Surviving Sepsis Campaign one-hour bundle in a short stay unit: A quality improvement project

Cited by 13 publications

References 19 publications

Combination of Prehospital NT-proBNP with qSOFA and NEWS to Predict Sepsis and Sepsis-Related Mortality

Combination of Prehospital NT-proBNP with qSOFA and NEWS to Predict Sepsis and Sepsis-Related Mortality

Impact of Sepsis Identification and Treatment Time on In-Hospital Mortality, Length of Stay, and Hours in the Intensive Care Unit

Association of Registered Nurse Staffing With Mortality Risk of Medicare Beneficiaries Hospitalized With Sepsis

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