158 A Multi-Baseline Intervention Study on Reducing Door to Fluid Times for Septic Patients

Abstract

The purpose of this study was to determine the impact of 2 different interventions on the time from recognition of sepsis at triage to the initiation of an intravenous fluid bolus (IVF) for all patients presenting to the emergency department (ED). This was a 16-month, retrospective chart review of a multi-baseline intervention, that measured the time, in minutes, to IVF initiation for all patients who presented to the ED with an initial triage assessment of sepsis. A positive triage assessment consisted of 2 or more systemic inflammatory response syndrome (SIRS) criteria plus suspected infection. The study site is located in a diverse suburban setting with a volume of 43,000 patients per year. The baseline process consisted of identification of a septic patient at triage without any overhead announcement nor immediate indication via the electronic medical record (EMR) to the receiving physician or primary nurse. Two sequential interventions were cumulatively compared from baseline. The first intervention was placement of a red “X” next to the patient’s name in the EMR (EMR-X) after triage identification of sepsis. The second intervention added an overhead announcement of “code sepsis” with the receiving physician and nurse names in addition to EMR-X (Code Sepsis-X). A total of 513 patients met sepsis criteria during the study period with Baseline: n = 311; EMR-X: n = 100; Code Sepsis-X: n = 102. Descriptive statistics were computed for study variables to ensure that all data values were within expected ranges. A one-way analysis of variance (ANOVA) was conducted to determine the impact of EMR-X and Code Sepsis-X on the number of minutes that it would take for patients presenting with signs of sepsis at triage to receive IVF. Three groups were created based on the process used to get the patient to receive the IVF. There was a statistically significant difference, F(2, 510) = 29.46, p < .001, in time depending on process used. Post-hoc comparisons showed that there was a significant difference between baseline (mean = 60.41 minutes) and EMR-X (50.79 minutes, p = .003), and baseline and Code Sepsis-X (38.28 minutes, p < .001). There was also a significant difference between EMR-X and Code Sepsis-X of 12.51 minutes, p = .002. Reducing the time between identification of sepsis and the initiation of a fluid bolus has become a national goal as it may decrease mortality associated with the septic patient. This study challenged the norm of triage identification only with implementation of electronic notification via the EMR and an overhead code announcement. Other time sensitive presentations such as stroke and trauma are announced overhead and sepsis was a natural extension of that process. Major improvement was seen after implementation of the overhead page as it immediately identified the primary physician and nurse, but also triggered the rest of the staff to respond as a team leading to greater efficiency. Instituting both processes had a cumulative effect. Future research will look to streamline the process further in order to deliver the most efficient care to patients presenting with sepsis.