Sepsis is one of the leading causes of death in the United States, particularly so for adults age 65 or older. To combat this potentially fatal complication, Houston Methodist Hospital implemented a four-part detection and management program, which has been very successful, according to a recent study published in The Joint Commission Journal on Quality and Patient Safety.
Houston Methodist originally began prioritizing sepsis detection and management in 2005, but the change in the sepsis death rate was marginal. As a result, the hospital shifted its focus to designing a new program in late 2007 that nurses would use to recognize signs of sepsis in patients early on.
The interventional program included the following four components.
1. Leadership. A multidisciplinary committee chaired by physicians was created to track screening statistics, evaluate the program's influence on patient outcomes and costs, and advocate for hospital policies and educational efforts that would improve patient care.
2. An early detection screening tool. According to the hospital officials, a tool that could help bedside nurses screen patients for early signs of sepsis while being seamlessly integrated into routine bedside nursing care and documentation processes was key to the program's success.
3. Screening and response protocols. The program committee used data collected from the screening efforts in the hospital's intensive care units to extend the protocols to inpatient units, such as the surgical units, as well as to patients who were admitted to the hospital from the emergency department or other healthcare facilities. Protocols were also created for how often to screen patients and how to treat patients who screened positive for sepsis symptoms.
4. Nurse education and training. Houston Methodist clinicians worked together to develop educational courses covering the epidemiology, signs and symptoms, and impact of sepsis, as well as in-service learning modules. Bedside nurses were tested to determine their mastery of the sepsis detection and treatment protocols.
Ultimately, the program was linked to an increase in the percent of patients screened for sepsis at Houston Methodist Hospital, from 10 percent in 2009 to 33 percent in 2011. Meanwhile, inpatient sepsis-associated death rates dropped from 29.7 percent before the program was implemented (from 2006 to 2008) to 21.1 percent after the program's implementation (from 2009 to 2014).
Further, the death rates and hospital costs for Medicare beneficiaries decreased during the study without a compensatory increase in discharges to post-acute care.
Despite the positive outcomes of the study, the researchers noted "further testing of the robustness and exportability of these programs is warranted."
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