Routine Screening for Sepsis in an Obstetric Population: Evaluation of an Improvement Project

• Published in: Permanente journal 2020-11, Vol.24 (5), p.1-10
• Main Authors: Champagne, Holly A, Garabedian, Matthew J
• Format: Article
• Language: English
• Subjects: Female; Hospital Mortality; Humans; Infant, Newborn; Intensive Care Units; Organ Dysfunction Scores; Original; Pregnancy; Retrospective Studies; Sepsis - diagnosis; Sepsis - epidemiology; Systemic Inflammatory Response Syndrome - diagnosis; Systemic Inflammatory Response Syndrome - epidemiology
• ISSN: 1552-5767; 1552-5775
• DOI: 10.7812/TPP/19.232

Our objectives were to calculate the timeliness of treatment following implementation of routine sepsis screening in an inpatient obstetric population using obstetric-adjusted systemic inflammatory response syndrome (SIRS) criteria, evaluate the performance of obstetric-specific screening criteria in the identification of sepsis, and to better characterize the frequency of end-organ dysfunction associated with those who met the definition of sepsis. Electronic medical record data were collected from all pregnant or newly delivered women admitted for observation, admission, or postpartum readmission in the hospital maternity unit from March 1 through December 31, 2017 (n = 5075). Combinations of SIRS criteria were collected and compared with clinical indicators of end-organ dysfunction in those who met the definition of sepsis. Maternal conditions and neonatal outcomes were evaluated. In the study period, 204 cases of sepsis were identified among 201 women, 2 of whom experienced multiple episodes of sepsis, resulting in an incidence of sepsis of 4.0 per 100 livebirths. There were 92 (45.2%) with sepsis and 112 (54.9%) with end-organ dysfunction. Two women were admitted to the intensive care unit and no women died from sepsis. Use of a standardized, obstetric-specific sepsis screening process provided for early identification and treatment of sepsis in this population. Fourteen unique combinations of SIRS criteria were noted among those with sepsis; no combination was uniquely associated with the severity of sepsis. Pregnant and newly delivered women benefitted from implementation of routine sepsis screening; this resulted in timely initiation of treatment.