3 Key Factors for an Effective
Sepsis Performance Improvement Program

  • There are several components to an effective sepsis performance improvement program.
  • Having a sepsis performance improvement program in itself maybe more important than the specific content, there are a few mandatory components required for effectiveness.
  • Including a large multidisciplinary clinical group is also essential for success.
  • If you are convinced the Surviving Sepsis Campaign (SSC) Guidelines are worth pursuing, a Sepsis Performance Improvement Programs (SPIP) can aid with improved sepsis protocol adherence.
  • Components of a SPIP are:
    • Use of screening tools
    • Multidisciplinary workgroup
    • Involvement of Emergency Department, Ward and ICU
    • Workflow changes in sepsis care pathways (independent of patient location)
    • Metrics of success with frequency of measurements
    • Data Collection forms
    • Educational Process
  • The exact sepsis bundle components resulting in the greatest reduction of mortality remains unknown.
  • Therefore, it appears having a SPIP in itself may be more important than the specific content of the program.

Factor 1: Sepsis Screening Tool

  • Notification via an automated tool of a suspected infection or sepsis is a basic requirement.
  • However, a screening tool is NOT THE SAME as a sepsis diagnosis.
    • Sepsis diagnosis remains a clinical assessment
    • The tool simply indicates which patients need a more in depth review.
  • There are a large number of sepsis screening tools advocated for use.
  • These consist of:
    • SIRS Criteria
    • Modified Early Warning Score (MEWS)
    • National Early Warning Score (NEWS)
    • Quick Sequential Organ Failure Score (qSOFA)
  • The accuracy of these scores are highly variable, with none of them superior to the others in identifying sepsis across studies.
  • All tools are subject to a large number of false positives, without a robust sensitivity, specificity or both.
  • Due to its poor sensitivity, qSOFA has been recommended NOT to be used for screening purposes.
  • To be most effective, all sepsis screening alerts should be combined with a mandatory and immediate clinical evaluation.
Factor 2: Sepsis Care Pathways

  • Following the identification of a potential sepsis patient, the clinical pathways should be promptly initiated.
  • The most studied critical process is the implementation of a sepsis response team as opposed to one consultant clinician.
  • Dedicated teams which respond collectively contribute to improve bundle compliance and mortality
  • Nurse-driven sepsis protocols are also a practical and beneficial collective team approach.
Factor 3: Sepsis Educational Program

  • Education is an essential piece of a SPIP to help raise awareness.
  • This includes:
    • Educational materials
    • Lectures
    • Bedside teaching
    • Case examples
    • Simulations
  • Although educational programs alone can improve sepsis outcomes, the combination of education and process change.


  • Regardless of the amount spent, treatment of sepsis is consistently expensive globally.
  • Intensity of care of individual patients does not reflect the cost of healthcare sepsis expenditures
  • General ward costs are greater than ICU costs, most likely due the length of stay being longer on the ward than ICU and a large proportion of patients admitted to the general ward.

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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.