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Accelerating Detection and Intervention for Sepsis in Skilled Nursing Facilities Using a Sepsis Pathway
Asma M Ahmed1, Efy Macapili, Michael J Brenner
1COVID Operations, United Health Care, Valencia, California (Dr Ahmed); Santa Clarita Nursing Facility, Newhall, California (Ms Macapili); Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, and Global Tracheostomy Collaborative, Raleigh, North Carolina (Dr Brenner); and Department of Nursing Faculty, and Outcomes After Critical Illness and Surgery Research Group, Johns Hopkins University, Baltimore, Maryland (Dr Pandian).
Background:
Early detection of sepsis decreases mortality in hospitals, but recognition of sepsis is often delayed in skilled nursing facilities (SNFs).
Local Problem:
A local SNF in the northeastern United States sought to use a standardized sepsis pathway to prevent hospital readmissions due to sepsis.
Methods:
A pre-/postimplementation design was used for this project. Outcome measures included sepsis detection and treatment, length of stay in the SNF, sepsis-related hospital transfer rate, mortality rate, and predictors of clinical outcomes.
Interventions:
A SNF sepsis pathway was developed based on current sepsis detection tools. The pathway incorporated a sepsis screening tool and a sepsis bundle. Implementation of the pathway involved education of nurses and certified nursing assistants on the pathway.
Results:
A total of 178 patients were included in data analysis (81 preimplementation and 97 implementation). Sepsis recognition increased from 56% to 86% ( P < .001), and sepsis-related hospital transfers decreased from 68% to 44% ( P = .07). Laboratory testing for lactate, white blood cell count, and blood cultures increased, and sepsis intervention rates significantly improved ( P < .001).
Conclusions:
Implementing a modified SNF sepsis pathway accelerated identification of sepsis and improved clinical outcomes.
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