Although institutions worldwide are acknowledging the decrease in mortality from therapies presented within the Surviving Sepsis campaign, many have encountered major obstacles in implementation. At our tertiary care, University Hospital facility we devised a “hospital-centric” sepsis pathway using a multi-format educational approach. We believe an educational program emphasizing ways to identify patient signs and symptoms is a more efficient way to improve outcomes, rather than appropriating resources to a specialized team, such as a Rapid Response Team.
As an institution-wide performance improvement project, we introduced a sepsis protocol in our institution’s Medical, Cardiac, Cardiothoracic, Surgical, and Neurological Critical Care Units, to be implemented in the immediate resuscitation of patients in severe sepsis (SS). The S.E.P.S.I.S. program was entitled “The Need For Speed”. A simple one page flow diagram was distributed as the sepsis pathway in every bedside nursing folder, together with a three page companion outlining current evidence-based-therapies in treating SS. After introducing the sepsis pathway to the house staff and nursing staff, we collected performance improvement data from May 2004-August 2004 focusing on protocol milestone goals and mortality. Our “bundle” was time to antibiotics, CVP ≥8, MAP ≥65, and SvO2 ≥70 (Chest 2004,126:863S). During that time we educated all workers involved in patient care, with regards to our Educational Program. This included weekly educational sessions, focused on the sepsis protocol and the reasoning behind milestone goals. Also, bedside teaching regarding therapy for SS was conducted during ICU rounds. During a second period, September 2004 –October 2004, we again assessed milestone and mortality data. Our results were presented to our institution’s Performance Improvement committee. This project was approved by our Institutional Review Board.
We achieved a significant reduction in mortality of patients using our multi-format educational approach without a Rapid Response Team.
Others may wish to incorporate all or part of our multi-format, “hospital-centric” educational approach. We believe that we will sustain our decreased mortality of patients with SS through this approach.
Mortality and Apache II Scores Across Education Program ImplementationMortalityMean Apache IIInitiation of S.E.P.S.I.S. (5/04-8/04)47%28 ± 6Completion S.E.P.S.I.S. (9/04-10/04)31%27 ± 6
Achievement of Therapeutic Milestones With Education IntegrationTime to AbxTime to CVPTime to MAPTime to SvO2Initiation of S.E.P.S.I.S2.674.113.776.97Completion of S.E.P.S.I.S0.412.951.293.28
Avelino Verceles, None.