Using quality improvement principles to improve the care of patients with severe sepsis and septic shock

Sepsis, an inflammatory response to an infection that may lead to severe organ dysfunction and death, is the leading cause of death in medical intensive care units. The Society of Critical Care Medicine has issued guidelines and promoted protocols to improve the management of patients with severe se...

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Bibliographic Details
Published in:The Ochsner journal 2013, Vol.13 (3), p.359-366
Main Authors: Seoane, Leonardo, Winterbottom, Fiona, Nash, Teresa, Behrhorst, Jessica, Chacko, Elen, Shum, Lucas, Pavlov, Andrey, Briski, David, Thibeau, Shelley, Bergeron, Dominique, Rafael, Tiffany, Sundell, Erik
Format: Article
Language:English
Subjects:
Antibiotics
Clinical outcomes
Communication
Critical care
Drug dosages
Emergency medical care
Hospitals
Intensive care
Medicine
Original Research
Patients
Pharmacists
Pneumonia
Quality control
Quality improvement
Sepsis
Vital signs
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Summary:Sepsis, an inflammatory response to an infection that may lead to severe organ dysfunction and death, is the leading cause of death in medical intensive care units. The Society of Critical Care Medicine has issued guidelines and promoted protocols to improve the management of patients with severe sepsis and septic shock. Generally, the medical community has been slow to adopt these guidelines because of the system challenges associated with protocol implementation. We describe an interdisciplinary team approach to the development and implementation of management protocols for treating patients with severe sepsis and septic shock. To determine the effectiveness of the bundled emergency department and critical care order sets developed by the Sepsis Steering Committee, we performed a case review of 1,105 sequential patients admitted to a large academic tertiary referral hospital with a diagnosis of severe sepsis or septic shock between July 2008 and January 2012. Implementation of the protocol led to improved order set use over time, a significant decrease in the median time to antibiotics of 140 (range 1-820) minutes in 2008 to 72 (range 1-1,020) minutes in 2011 (P≤0.001), and a decrease in median length of stay from 8 days (range 1-54) in 2008 to 7 days (range 1-33) in 2011 (P=0.036). A multidisciplinary team approach to sepsis management using protocols and early goal-directed therapy is feasible in a large academic medical center to improve the process of care and outcomes.
ISSN:1524-5012