The Surviving Sepsis Campaign Phase IV Collaborative
Sixty hospitals across the United States took part in a sepsis improvement program designed to improve outcomes in patients with new or worsening sepsis on the hospital wards. The initiative focused on embedding sepsis screening into patient assessment on every shift, every day. Many sites began this process on paper while creating new documentation platforms in their electronic health records (EHRs).
This nurse-driven process was initially piloted on a single unit. Every patient was screened every day on every shift, using the questions outlined on the severe sepsis screening tool. Experience suggests that sepsis screening is best performed at the beginning of the shift along with the routine patient assessment, and again in association with any change in patient condition.
A sample severe sepsis screening tool was provided to participating sites, which were asked to operationalize screening using the following rubric:
Does the patient have an infection or suspected new infection?
Does the patient have two or more signs or symptoms of infection?
Does the patient have a new organ failure that is considered to be related to the infection?
All questions must be answered affirmatively before initiating the 3-hour bundle. Some sites used clinical decision support incorporated in their EHR systems to create an automated “sepsis alert” to improve timeliness of sepsis screening surveillance.
The pilot units were a mix of medical, medical/surgical, and other units. The nurse-to-patient ratio on the pilot units ranged from 1:4 to 1:9 (70% had ratios of 1:4 or 1:5). The time to complete the screening was 5-20 minutes per patient, depending on the tool used and the level of staff expertise. Although the time required may seem onerous, 75% of the sites achieved ≥ 80% screening compliance by the end of the 18-month period.
Is this sepsis?