Reductions in Sepsis Mortality and Costs After Design and Implementation of a Nurse-Based Early Recognition and Response Program

Abstract

Background 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. Methods 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. Results 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. Conclusion 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.

Evaluation of User-Interface Alert Displays for Clinical Decision Support Systems for Sepsis

“…9 Health care organizations are increasingly turning to CDS systems for sepsis, which provide clinicians with patient-specific assessments and recommendations to promote recognition and aid in evidence-based clinical decision-making. 10,11 …”

Experiences and Conclusions of the Hungarian Emergency Sepsis Register

“…There is a growing body of evidence that timely management of sepsis decreases morbidity and mortality [16] [17] also contributing to the lowering of health care costs [18]. With the introduction of the Hungarian Emergency Sepsis Register we wanted to determine where and how we can improve our activity on the battlefield of sepsis in the front line.…”

Bacterial sepsis

“…Surprisingly, completion of the fluid bolus and thus hemodynamic stabilization in the acute phase seemed to be (at least in this study) less relevant for a sepsis patient's survival. Integration of ICU nurses into the treatment team is of high relevance, and studies have shown that this also reduces mortality [47,48].…”