Managing sepsis: Electronic recognition, rapid response teams, and standardized care save lives

Highlights

• EHR-based, sepsis-recognition tool provided hourly, hospital-wide sepsis screening.

• Adjusted MEWS-SRS score was tailored to screen for sepsis at our institution.

• Nurse-led Rapid Response Team was instrumental in sepsis care delivery on the wards.

• Hospital-wide sepsis alert order set was based on a simplified 3 h bundle.

• Associated reductions in mortality, length of stay, and mechanical ventilation use.

Abstract

Purpose

Sepsis can lead to poor outcomes when treatment is delayed or inadequate. The purpose of this study was to evaluate outcomes after initiation of a hospital-wide sepsis alert program.

Materials and methods

Retrospective review of patients ≥ 18 years treated for sepsis.

Results

There were 3917 sepsis admissions: 1929 admissions before, and 1988 in the after phase. Mean age (57.3 vs. 57.1, p = 0.94) and Charlson Comorbidity Scores (2.52 vs. 2.47, p = 0.35) were similar between groups. Multivariable analyses identified significant reductions in the after phase for odds of death (OR 0.62, 95% CI 0.39–0.99, p = 0.046), mean intensive care unit LOS (2.12 days before, 95%CI 1.97, 2.34; 1.95 days after, 95%CI 1.75, 2.06; p < 0.001), mean overall hospital LOS (11.7 days before, 95% CI 10.9, 12.7 days; 9.9 days after, 95% CI 9.3, 10.6 days, p < 0.001), odds of mechanical ventilation use (OR 0.62, 95% CI 0.39, 0.99, p = 0.007), and total charges with a savings of $7159 per sepsis admission (p = 0.036). There was no reduction in vasopressor use (OR 0.89, 95% CI 0.75, 0.1.06, p = 0.18).

Conclusion

A hospital-wide program utilizing electronic recognition and RRT intervention resulted in improved outcomes in patients with sepsis.

Introduction

Sepsis is a life-threatening, dysregulated host response to infection that leads to organ dysfunction [1] and is the primary cause of death from infection [2]. Over 750,000 cases of sepsis occur annually in the United States, with the number and rate of hospitalizations tripling over the last two decades and continuing to climb each year [2], [3], [4]. Sepsis was also the most expensive condition billed to Medicare in 2011, costing over $20 billion that year [5]. Care for sepsis patients frequently involves prolonged length of stay (LOS) incurring higher overall healthcare costs [6]. According to the Centers for Disease Control, patients hospitalized for sepsis had an average LOS that was 75% longer than patients hospitalized for other conditions [2]. Given that the rate of hospitalization for sepsis is much higher for those aged 65 and over, the incidence is expected to continue to grow with the aging U.S. population [3], [6], [7].

Sepsis mortality decreases with early recognition and treatment [1], [8]. Therefore, sepsis screening and early, aggressive care is vital to increasing the chance of survival. Implementation of Surviving Sepsis Campaign (SSC) guidelines, an international effort promoting widespread early recognition and implementation of treatment bundles, have been associated with mortality reduction in sepsis [8], [9]. At our institution, we implemented a multidisciplinary, hospital-wide program which included an electronic health record (EHR) sepsis recognition tool, education, standardized management bundles, and designated team responders for each area of the hospital including the rapid response team (RRT) for inpatients. The purpose of this study was to determine the effect of the sepsis alert program on the primary outcome of inpatient mortality and secondary outcomes including intensive care unit (ICU) LOS, hospital LOS, mechanical ventilation use, vasopressor use, and hospital charges per sepsis admission.