SUMMARY

• Sepsis performance improvement programs can optimize compliance with sepsis protocols and are associated with improved patient outcomes.
• Having a Sepsis Performance Improvement program is more important than the specific content of the program.
• Engaging a large multidisciplinary group of clinical leaders is essential for success.

REVIEW

• Despite variances in Sepsis Performance Improvement Programs, they are consistently associated with increased bundle compliance.
• Although there are multiple components to a Sepsis Performance Improvement Program, the factors independently associated with improved bundle compliance and decreased mortality are:
  • Use of Screening tools
  • Workflow Process Changes
  • Educational Programs

USE OF SCREENING TOOLS:

• The goal of sepsis screening tools is NOT to diagnose sepsis, but rather for early identification of possible sepsis cases requiring further evaluation.
• Sepsis screening alone will not result in improved performance measures or patient outcomes.
• A large number of risk scores and screening tools are available (SIRS, MEWS, NEWS, qSOFA)
• None are superior to any other
• Accuracy of the tools are highly variable
• All are susceptible to false positive findings
• Artificial intelligence may help improve the value of these tools.

WORKFLOW PROCESS CHANGES:

• Once a suspected sepsis patient has been identified, implementation of the response is the most critical step.
• Dedicated teams to respond to sepsis alerts, prevents placing the full burden of responsibility on a single extremely busy individual.
• The use of a dedicated team has proven improved clinical outcomes.

• Other process changes contributing to better bundle adherence include:
  • Printed/easily accessible protocols
  • Standardized order sets
  • Frequent auditing
  • Nurse driven protocols

EDUCATIONAL PROGRAMS:

• Increased awareness of the sepsis approach via an educational program is essential.
• Education materials could consists of:
  • Lectures
  • Bedside teaching
  • Simulation training

ADDITIONAL CONSIDERATIONS:

• It remains to be seen if improved patient outcomes are due to:
  • Care bundle adherence
  • If 1 bundle element is of greater value than any other
  • If increased awareness irrespective of bundle adherence is important.
• Should we be considering other endpoints than mortality, such as:
  • Resource use
  • Duration of invasive treatments
  • Development of organ dysfunction requiring high levels of care

CONCLUSIONS:

• Implementing a Sepsis Performance Improvement Program is associated with a number of improvements in care processes and patient outcomes.
• Dedicated sepsis teams increase collaborative and timely discussions.
• Workflow changes allow incorporation of clinical judgement while applying the recommended elements of sepsis care.

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (erkan@spo.icu), or video chat.