Toward Standardization and High Reliability: Improved Sepsis Screening in Emergency Department Triage Across an...

Area of Science:

• Emergency Medicine
• Healthcare Quality Improvement
• Clinical Workflow Optimization

Background:

• Sepsis is a critical, life-threatening condition requiring prompt recognition and treatment in the emergency department (ED) to improve patient outcomes.
• Early sepsis detection is vital for reducing mortality and morbidity.

Purpose of the Study:

• To implement and assess an interdisciplinary quality improvement (QI) project to standardize sepsis screening workflow across an academic health system.
• To improve sepsis screening rates, reduce sepsis-related mortality, and enhance compliance with the Centers for Medicare & Medicaid Services (CMS) sepsis bundle (SEP-1).

Main Methods:

• A quality improvement project utilizing the Institute for Healthcare Improvement Model for Improvement framework with iterative Plan-Do-Study-Act (PDSA) cycles.
• Standardized an electronic health record (EHR)-based sepsis screening workflow at ED triage across four hospitals (one tertiary, one freestanding ED, two rural affiliates).
• Compared pre- and post-intervention sepsis screening rates, sepsis mortality (observed to expected ratio), and SEP-1 bundle compliance using two-tailed t-tests.

Main Results:

• Sepsis screening rates significantly increased across all sites post-intervention, rising from baseline rates (1.7%-36.5%) to over 90% (91.9%-99.0%) after four PDSA cycles (p < 0.005).
• Sepsis screening increased most slowly at the main academic medical center, requiring progressive PDSA cycles to exceed 90% compliance.
• While sepsis mortality (O:E ratio) decreased from 0.99 to 0.83 (p=0.07) and CMS SEP-1 bundle compliance increased from 28.4% to 40.5% (p=0.14), these changes were not statistically significant.

Conclusions:

• An interdisciplinary QI project effectively leveraged EHR optimization and human workflows to standardize and improve sepsis screening in the ED.
• The project demonstrated a significant increase in sepsis screening rates, suggesting potential for improved sepsis management.
• Although not statistically significant, observed trends indicated reduced sepsis mortality and increased bundle compliance, warranting further investigation.