787. Improving ED Sepsis Care

Abstract

BackgroundSepsis is a severe, life-threatening illness in response to an infection from the body’s immune system. Sepsis can progress rapidly, causing hypotension, organ failure, and death. Mortality from severe forms of sepsis and septic shock range between 20% to 50%, but with appropriate and timely treatment, mortality decreases to 5%-10%. Before completing the Improving ED Sepsis Care project, there was only 18% and 12% compliance with the CMS 3 and 6-hour core measure bundles, respectively, within the Ochsner Main Campus Emergency Department.MethodsA multi-disciplinary team followed Lean methodology for process improvement. The failure to identify sepsis patients as high acuity in triage was a key root causes identified. There was also a need to simplify the process and workflow to facilitate antibiotic administration and resuscitation. A triage tool called “Code Sepsis” was created to allow for early identification of severe forms of sepsis, to ensure an appropriate ESI score, and to dedicate immediate attention from staff. A provider order set was created that included the necessary lab work standardized antibiotics.Results3-hour bundle compliance increased from 18% to 90% following the intervention. Improvements were noted in time to antibiotic administration, volume resuscitation, and appropriate initiation of vasopressors. The addition of the “Code Sepsis” triage tool decreased the median time to antibiotic administration from 1 hour 53 minutes to 33 minutes. Improvements were also noted in the elements of the 6-hour “perfect care” bundle; however, compliance rates were lower than goal.ConclusionEarly identification and appropriate treatment of sepsis is key to improving survival. Despite widespread knowledge early treatment, many EDs struggle to meet the CMS sepsis care bundles. Utilizing the Lean framework allowed the improvement team to breakdown a multi-siloed, interdependent care process. Disclosures All authors: No reported disclosures.