Improving Sepsis Outcomes for Acutely Ill Adults Using Interdisciplinary Order Sets

Abstract

The objective of the study was to measure outcomes following implementation of standardized order sets for managing patients with severe sepsis/septic shock. Sepsis is a severe illness, affecting approximately 750 000 people in the United States, with mortality rates of 28% to 50%, and costing $17 billion each year. An interdisciplinary team was created to improve early recognition and process of care in patients with severe sepsis/septic shock. Education was rolled out over 6 months, and sepsis "bundle" order sets were implemented. Adult patients (N = 674) with a diagnosis of severe sepsis or septic shock who were admitted to an emergency department or critical care unit at a 563-bed tertiary care teaching facility from May 2008 through October 2010 were included in data analysis. A plan, do, study, act methodology was used. Outcomes following project implementation were measured prospectively including appropriate recognition of patients with a diagnosis of sepsis, hospital site where the order set was initiated, and attainment of treatment goals within 6 hours of onset of severe sepsis/septic shock. When order set usage was analyzed, the use of order sets was significantly associated with meeting "6-hour goals" successfully (χ1 [n = 662] = 36.16, P < .001); order set usage explained 24% of the variation in meeting goals, R = 0.24, F1,661 = 38.51, P < .0001. Order sets improved management of septic patients through effective change in delivery systems to support evidence-based medical care. Administrative support, team collaboration, and standardized order sets can lead to improved process of care.