1059

Abstract

Introduction: Poor provider compliance with Surviving Sepsis Campaign clinical guidelines has been shown to be a limiting factor in achieving the positive outcomes that research evidence predicts. Methods: We used a baseline (n = 163) - follow-up (n = 160), quasi-experimental design with a historical comparison group. We retrieved data for two years prior to and one year following the 2012 intervention from systematic random sampling of medical records of all patients with sepsis-related ICD-9 codes and patient discharge data (n = 1710) at a 242-bed eastern community hospital. Healthcare providers (n = 308) participated in an online didactic and on-site simulation education program. Sepsis knowledge was tested at five points: pretest, online module posttest, simulation posttest, reassessment, and simulation refresher posttest. Results: Gain in staff knowledge and retention was significant, f(4) = 5.82, p < .001. Posttest compliance with completing all 6-hour bundle elements was significant (z = -5.99, p < .001, OR = 3.60). Compliance was highest for drawing serum lactate (z = -2.65, p = .004, OR = 2.41) and initial fluid administration (z = -5.99, p < .001, OR = 2.99). Pre and post groups were demographically similar, yet post intervention patients appeared to present with more severe symptoms, suggesting more thorough initial assessment by clinicians (temperature < 36 C (z = -1.91, p = .028), urinary output < 0.5ml/kg/2hrs (z = -2.45, p = .007), altered mental status (chi2 = 12.50, p = .002), pulmonary infection (z = -5.99, p < .001). Logistic regression revealed that post-intervention patients were less likely to receive DRG 870 (most severe) (B = -0.13, p = .93 OR = .88) and DRG 871 (moderately severe) B = -0.99, p = .04, OR = 0.37), and more likely to receive DRG 872 (least severe) B = 1.30, p = .02, OR = 3.68. Changes in mortality and LOS were non-significant, possibly due to high baseline performance. However, discharge data revealed a 15.26% lower post-intervention mortality rate. Conclusions: An online and simulation educational intervention for staff caring for sepsis patients resulted in significant gains in sepsis diagnosis and management knowledge over time, improved compliance with administering 6-hour sepsis bundle elements, and a post-intervention shift to lower acuity DRGs.