Early, Nurse-Directed Sepsis Care.

Area of Science:

• Quality Improvement
• Healthcare Management
• Infectious Diseases

Background:

• Sepsis is a leading cause of hospital mortality and readmissions.
• Research has primarily focused on severe sepsis cases, neglecting early or less severe presentations.
• Effective strategies for early sepsis recognition and management in non-critical care settings are needed.

Purpose of the Study:

• To implement and evaluate a quality improvement initiative for early sepsis recognition and treatment.
• To establish a multidisciplinary, executive-led sepsis guiding team.
• To leverage nursing expertise in sepsis management.

Main Methods:

• Implemented a nurse-directed "Code Sepsis" in the ED and "Power Hour" for inpatients.
• Authorized nurses to independently initiate sepsis order sets (lactate, blood cultures, fluids).
• Conducted a seven-year retrospective interrupted time-series analysis of sepsis-related mortality and process metrics.

Main Results:

• Sepsis bundle adherence increased from 40.5% to 73.7% in the ED (P < 0.001).
• Sepsis-related rapid response calls decreased from 2.2% to 0.85% (P < 0.001).
• In-hospital sepsis-related mortality rate decreased from 12.5% to 8.4% (P < 0.001).

Conclusions:

• Nurse-directed care effectively promotes timely sepsis identification and treatment.
• Early sepsis intervention improves bundle adherence and reduces in-hospital mortality.
• This QI initiative demonstrates a successful model for sepsis management across care settings.