School of Medicine and Health Sciences Poster Presentations

Implementation of a Systematic Standardized Hospital Screening Protocol for Sepsis at the George Washington University Hospital

Poster Number

306

Document Type

Poster

Publication Date

3-2016

Abstract

Background: Medical interventions specific to the Emergency Department (ED) have come a long way in executing quality improvement efforts of sepsis management, as outlined in the Surviving Sepsis Campaign guidelines. Although many clinically­ guided recommendations have been made thanks to the therapeutic advances of large, multicenter randomized control trials (ProCESS, ARISE, PROMISE), there has been no clear superior evidence-based method of screening. Furthermore, the optimal treatment of severe sepsis and septic shock is a dynamically evolving process. Rapid response in identifying these patients and administering aggressive treatment within the initial hours of suspected physiological changes is not only crucial to improve the odds of survival, but also can greatly influence long­term outcomes.

Objective: The goal of this study is to evaluate the impact of a newly-designed systematic protocol to screen adult patients presenting with possible sepsis risk to an academic ED at a University Hospital, a site that lies at the 80th percentile in 2014 for overall sepsis mortality among its teaching hospital counterparts. We hypothesize that early screening and intervention, in addition to improvement initiatives such as education training programs for ER staff, will decreased time from triage to antibiotics administration (TTAA) which will lower hospital mortality septic patients.

Methods: A multidisciplinary hospital sepsis committee consisting of physician, nursing, and pharmacy leadership, was established to address late sepsis recognition and above average mortality at GW. Based on the committee recommendation, a formalized screening process was suggested to quickly assess and treat patients with a potential sepsis in the ER. The screening protocol consists of two branches. The first mechanism identifies patients during triage through a nurse driven screening process (Figure1). The second mechanism is implemented when a patient who was not identified septic in triage and develops signs of sepsis in the ED. The implementation stage of the screening protocol involved multidisciplinary team education, including nurses and ED Physicians, and rewarding of timely sepsis screening and treatment.

Results: We identified 100 sepsis patient over around 10 weeks before and after the intervention (Figure2). We applied a liner regression model to look at the reduction of TTAA vs days of service (DOS) which showed a significant reduction at p value of 0.0466 (Figure3). As a last step we applied Generalized Additive Model (GAM) to TTAA vs DOS and Mortality vs DOS (Figure4,5).

Conclusions: We think applying this intervention will lead to early detection of septic patient and early antibiotic administration

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Presented at: GW Research Days 2016

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Implementation of a Systematic Standardized Hospital Screening Protocol for Sepsis at the George Washington University Hospital

Background: Medical interventions specific to the Emergency Department (ED) have come a long way in executing quality improvement efforts of sepsis management, as outlined in the Surviving Sepsis Campaign guidelines. Although many clinically­ guided recommendations have been made thanks to the therapeutic advances of large, multicenter randomized control trials (ProCESS, ARISE, PROMISE), there has been no clear superior evidence-based method of screening. Furthermore, the optimal treatment of severe sepsis and septic shock is a dynamically evolving process. Rapid response in identifying these patients and administering aggressive treatment within the initial hours of suspected physiological changes is not only crucial to improve the odds of survival, but also can greatly influence long­term outcomes.

Objective: The goal of this study is to evaluate the impact of a newly-designed systematic protocol to screen adult patients presenting with possible sepsis risk to an academic ED at a University Hospital, a site that lies at the 80th percentile in 2014 for overall sepsis mortality among its teaching hospital counterparts. We hypothesize that early screening and intervention, in addition to improvement initiatives such as education training programs for ER staff, will decreased time from triage to antibiotics administration (TTAA) which will lower hospital mortality septic patients.

Methods: A multidisciplinary hospital sepsis committee consisting of physician, nursing, and pharmacy leadership, was established to address late sepsis recognition and above average mortality at GW. Based on the committee recommendation, a formalized screening process was suggested to quickly assess and treat patients with a potential sepsis in the ER. The screening protocol consists of two branches. The first mechanism identifies patients during triage through a nurse driven screening process (Figure1). The second mechanism is implemented when a patient who was not identified septic in triage and develops signs of sepsis in the ED. The implementation stage of the screening protocol involved multidisciplinary team education, including nurses and ED Physicians, and rewarding of timely sepsis screening and treatment.

Results: We identified 100 sepsis patient over around 10 weeks before and after the intervention (Figure2). We applied a liner regression model to look at the reduction of TTAA vs days of service (DOS) which showed a significant reduction at p value of 0.0466 (Figure3). As a last step we applied Generalized Additive Model (GAM) to TTAA vs DOS and Mortality vs DOS (Figure4,5).

Conclusions: We think applying this intervention will lead to early detection of septic patient and early antibiotic administration