PURPOSE: Implementation of our Slay Sepsis Protocol in 2005 led to a reduction in septic shock mortality from 46% to 23-27%, sustained over 4 years. We sought to determine if applying a Lean Improvement Process used in the manufacturing industry, to our already successful Slay Sepsis Protocol, could further improve process measures and outcomes.
METHODS: A two day review of all aspects of our Slay Sepsis Protocol by representatives of all involved departments was conducted in January 2010. Lean Improvement techniques were applied to improve processes and efficiency and eliminate waste. Continuous daily and weekly review was performed by quality improvement nurses and appropriate feedback was given to department managers weekly. Data was collected as part of our IRB approved Sepsis Registry.
RESULTS: Multiple improvements to processes were developed with a focus on ED triage, treatment and transfer to ICU. Additionally a novel ED sepsis triage system was developed: 3 Levels of sepsis patients were identified at triage based on modified SIRS criteria and parameters defined for acuity. Nursing and other resources assigned to these patients were matched to their Sepsis level, and electronic order sets for each level were developed. Full code pts admitted thru ED were evaluated. 58 pts with septic shock Jan 2009-Feb 2010 ("Pre") were compared to 78 pts Feb 2010-Dec 2010 post-implementation ("Post"). All values are Pre vs Post: APACHE II 25 vs 24 (p=0.22); ED Fluids ml/kg 36.8 vs 34.4 (p=0.97); Triage to Antibiotics (min) 124 vs 83 (p=0.01); Suspect sepsis to Antibiotics (min)101 vs 50 (p=0.003); Triage to Central Line (min) 331 vs 200(p=0.028); Triage to ScvO2 (min)456 vs 346 (p=0.019); Mortality 24.1% vs 15.3%(p=0.29); Survivors Hospital LOS (days) 8 vs 6 (p=0.06)
CONCLUSIONS: A manufacturing inspired Lean Improvement process led to significant improvements in efficiency, a novel 3 tier system of ED triage for sepsis pts, and this translated to significant improvement in clinical processes and outcomes.
CLINICAL IMPLICATIONS: Lean manufacturing techniques can be applied to clinical processes and may yield novel solutions, increased efficiency and improved outcomes.
DISCLOSURE: The following authors have nothing to disclose: Jeffrey Fried, Maggie Cote, Emily Atkins, Denise McDonald, Paula Gallucci, Alexa Calfee, Jonathan Grotts, Nathan Sigler
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