Sepsis Response Team Research Articles

Impact of a Coordinated Sepsis Response on Time to Treatment in a Pediatric Emergency Department.

Sepsis is responsible for 75 000 pediatric hospitalizations annually, with an associated mortality rate estimated between 11% and 19%. Evidence supports the use of timely fluid resuscitation and antibiotics to decrease morbidity and mortality. Our emergency department did not meet the timeliness goals for fluid and antibiotic administration suggested by the 2012 Surviving Sepsis Campaign. In November 2018, we implemented a sepsis response team utilizing a scripted communication tool and a dedicated sepsis supply cart to address timeliness barriers. Performance was evaluated using statistical process control charts. We conducted observations to evaluate adherence to the new process. Our aim was to meet the Surviving Sepsis Campaign's timeliness goals for first fluid and antibiotic administration (20 and 60 minutes, respectively) within 8 months of our intervention. We observed sustained decreases in mean time to fluids. We also observed a shift in the proportion of patients receiving fluids within 20 minutes. No shifts were observed for timely antibiotic administration. The implementation of a dedicated emergency department sepsis response team with designated roles and responsibilities, directed communication, and easily accessible supplies can lead to improvements in the timeliness of fluid administration in the pediatric population.

A nursing-led sepsis response team guiding resuscitation with point-of-care ultrasound: A review and model for improving bundle compliance while individualizing sepsis care.

A dysregulated host response to infection resulting in life-threatening organ dysfunction defines the onset of sepsis. Unfortunately, sepsis is common, costly, and deadly. The Surviving Sepsis Campaign publishes regularly updated, evidence-informed, detection, and treatment guidelines culminating in time-sensitive care "bundles." The goal of these bundles is to expedite sepsis recognition because it is widely held that early treatment is life-saving. Hospitals are mandated to publicly report their bundle compliance, and this will soon be tied to hospital reimbursement. For these reasons, hospitals are creating sepsis emergency response teams which are a form of a rapid response team consisting of dedicated medical professionals who evaluate patients with suspected sepsis and initiate therapy when appropriate. Evidence to date support sepsis emergency response teams as a mechanism to improve bundle compliance, and potentially, patient outcome. Nevertheless, some elements of bundled sepsis care are controversial (e.g., intravenous fluid administration) as some argue that mandated treatment precludes personalized care. Herein, we briefly describe general sepsis emergency response team structure, review evidence supporting sepsis emergency response teams to improve bundle compliance and patient outcome and report our unique experience incorporating point of care ultrasound-to guide intravenous fluid-into a nursing-led sepsis team. We propose that our sepsis emergency response team approach allays concern that sepsis care is either bundled or personalized. Instead, incorporating point of care ultrasound into a nursing-led sepsis emergency response team increases bundle compliance and individualizes care.

The impact of a sepsis performance improvement program in the emergency department: a before–after intervention study

PurposeThe latest Surviving Sepsis Campaign guidelines advocate that all hospitals use sepsis performance improvement programs. However, there is a limited evidence about how to structure such programs and what their potential impact is on sepsis management and outcomes in the emergency department (ED). In this study, we evaluated the implementation of a sepsis performance improvement program in the ED including a dedicated sepsis response team and analyzed the management and outcomes of sepsis patients before and after.MethodsWe conducted a before–after interventional study in the ED of the Amsterdam University Medical Centers, the Netherlands. The sepsis performance improvement program included regular educational meetings, daily audits and weekly feedback, a screening tool, and a dedicated multidisciplinary sepsis response team. We studied all adult patients who presented to the ED with a suspected infection and a Modified Early Warning Score (MEWS) ≥ 3 during their stay. In the postintervention phase, these patients were seen by the sepsis team. Process-related and patient-related outcomes were measured between November 2019 and February 2020 (preintervention) and December 2021–May 2022 (postintervention).ResultsA total of 265 patients were included in the primary study, 132 patients preintervention and 133 patients postintervention. The postintervention phase was associated with improvements in nearly all process-related outcomes, such as a shorter time to antibiotics (66 vs. 143 min; p < 0.001), increased number of lactate measurements (72.9 vs. 46.2%; p < 0.001), and improved completeness of documented MEWS scores (85.0 vs. 62.9%; p < 0.001). Except for an improvement in the number of immediate versus delayed ICU admissions (100% immediate vs. 64.3% immediate; p = 0.012), there was no improvement in the other patient-related outcomes such as 28 days mortality (14.3 vs. 9.1%; p = 0.261), during the postintervention phase.ConclusionOur program stimulated physicians to make timely decisions regarding diagnostics and treatment of sepsis in the ED. Implementing the sepsis performance improvement program was associated with significant improvements in most process-related outcomes but with minimal improvements in patient-related outcomes in our cohort.

Bedside Evaluation for Early Sepsis Intervention: Addition of a Sepsis Response Team Leads to Improvement in Sepsis Bundle Compliance.

Sepsis is associated with high morbidity and mortality and high healthcare costs. We hypothesized that a multifaceted quality improvement project would lead to an improvement in compliance with the sepsis "bundles." Patients presenting to the emergency department that met criteria for sepsis at triage triggered notification of an emergency department physician and the sepsis response team in order to facilitate timely completion of the 3-hour bundles. The primary outcome was compliance with the seven sepsis bundle components. Secondary outcomes included all-cause inhospital mortality, hospital length of stay, and time in the emergency department. The study was conducted at a 404-bed tertiary academic medical center over a 2-year period. The study included patients that presented to the emergency department that met criteria for sepsis. The study included 163 patients. Overall compliance with the sepsis bundle was 79% (95% CI, 72-84%). There was significant improvement in comparison with the hospital's historical compliance of 37% (p < 0.001). Compliance with the individual bundle components ranged from 80% to 100%. Sixteen patients died (10%) in the hospital. There was no statistically significant difference between the compliant and noncompliant groups regarding the secondary outcomes of length of stay or inhospital mortality. This study found that implementation of a sepsis response team can improve compliance with completion of sepsis bundles. This indicates that it is feasible to implement a multidisciplinary quality initiative to improve timely treatment of patients with sepsis at an academic center using a resident-driven sepsis response team.

Implementation of a Coordinated Sepsis Response Team to Improve Time to Sepsis Treatment

Implementation of a Coordinated Sepsis Response Team to Improve Time to Sepsis Treatment

The Impact of Early Identification and a Critical Care-Based Sepsis Response Team on Sepsis Outcomes.

The Impact of Early Identification and a Critical Care-Based Sepsis Response Team on Sepsis Outcomes.

The impact of a multifaceted intervention including sepsis electronic alert system and sepsis response team on the outcomes of patients with sepsis and septic shock

BackgroundCompliance with the clinical practice guidelines of sepsis management has been low. The objective of our study was to describe the results of implementing a multifaceted intervention including an electronic alert (e-alert) with a sepsis response team (SRT) on the outcome of patients with sepsis and septic shock presenting to the emergency department.MethodsThis was a pre–post two-phased implementation study that consisted of a pre-intervention phase (January 01, 2011–September 24, 2012), intervention phase I (multifaceted intervention including e-alert, from September 25, 2012–March 03, 2013) and intervention phase II when SRT was added (March 04, 2013–October 30, 2013) in a 900-bed tertiary-care academic hospital. We recorded baseline characteristics and processes of care in adult patients presenting with sepsis or septic shock. The primary outcome measures were hospital mortality. Secondary outcomes were the need for mechanical ventilation and length of stay in the intensive unit and in the hospital.ResultsAfter implementing the multifaceted intervention including e-alert and SRT, cases were identified with less severe clinical and laboratory abnormalities and the processes of care improved. When adjusted to propensity score, the interventions were associated with reduction in hospital mortality [for intervention phase II compared to pre-intervention: adjusted odds ratio (aOR) 0.71, 95% CI 0.58–0.85, p = 0.003], reduction in the need for mechanical ventilation (aOR 0.45, 95% CI 0.37–0.55, p < 0.0001) and reduction in ICU LOS and hospital LOS for all patients as well as ICU LOS for survivors.ConclusionsImplementing a multifaceted intervention including sepsis e-alert with SRT was associated with earlier identification of sepsis, increase in compliance with sepsis resuscitation bundle and reduction in the need for mechanical ventilation and reduction in hospital mortality and LOS.

Impact of Pharmacist Intervention on Selection and Timing of Appropriate Antimicrobial Therapy in Septic Shock

Background: Current guidelines for septic shock management recommend administration of appropriate, broad-spectrum antimicrobials within 1 hour of recognition. Objective: To evaluate the interventions pharmacists make as part of a sepsis response team and to determine if these interventions increase the proportion of patients with appropriate empiric antimicrobial therapy. Methods: A retrospective cohort study was undertaken reviewing adult patients in a large, academic medical center with confirmed septic shock who had an order for a “sepsis bundle,” which includes notification of a pharmacist to assess adequacy of empiric therapy. Pharmacist interventions with regard to selection of empiric antimicrobials were documented. The proportion of patients with initial successful selection of antimicrobial therapy (SSAT) before and after pharmacist intervention was assessed as well as the time to first antimicrobial administration and time to appropriate antimicrobial administration. Results: A total of 76 patients were included. Pharmacist intervention increased the proportion of patients with SSAT from 66% to 80% (P = .04). Median time to first antimicrobial administration was 43 minutes, and time to appropriate antimicrobial therapy was 1 hour, 34 minutes for the entire cohort, with pharmacist intervention decreasing the latter time significantly in patients without SSAT on initiation of the “sepsis bundle” (P < .001). Conclusion: Pharmacist assessment of patients in septic shock offers the opportunity to improve SSAT. Systems designed to use a pharmacist responder for the care of patients with septic shock maximize the selection of antimicrobials, facilitate rapid administration, and improve surrogate outcomes for mortality in septic shock.

Importance of Pharmacy Involvement in the Treatment of Sepsis.

Purpose: A review of the impact of pharmacists on appropriate medication selection, timing of administration, and as members of a multidisciplinary sepsis response team. Summary: Early goal-directed therapy (EGDT), currently recommended by the 2013 Surviving Sepsis Campaign guidelines for the management of patients with sepsis, includes the administration of appropriate antibiotics in patients with septic shock within the first hour. Multidisciplinary teams containing pharmacists have been shown to decrease time to antibiotic delivery, time to antibiotic administration, and patient mortality. The pharmacist can act as a drug information resource, expedite the medication verification and procurement process, and offer suggestions on how to better manage the patients. Pharmacists are often consulted for dosing and antibiotic selection recommendations for patients with sepsis, but they can also help increase the appropriateness of antibiotics selected. Additional recommendations and interventions made by pharmacists include fluid management and vasopressor facilitation for the more severe patients. A sepsis management team that included a pharmacist increased the number of patients receiving appropriate antibiotics within the first hour by as much as 22-fold. Another study has demonstrated that intensive care units with a pharmacist are associated with a 4% decrease in sepsis patient mortality compared to those without a pharmacist. Conclusion: Multidisciplinary teams containing pharmacists have been shown to decrease time to administration of antibiotics, increase appropriate selection of medications, and decrease mortality; they may also decrease overall health care costs.

Sepsis and Shock Response Team: Impact of a Multidisciplinary Approach to Implementing Surviving Sepsis Campaign Guidelines and Surviving the Process.

The Surviving Sepsis Campaign guidelines are designed to decrease mortality through consistent application of a 7-element bundle. This study evaluated the impact of improvement in bundle adherence using a time-series analysis of compliance with the bundle elements before and after interventions intended to improve the process, while also looking at hospital mortality. This article describes interventions used to improve bundle compliance and hospital mortality in patients admitted through the emergency department with sepsis, severe sepsis, or septic shock. Quality improvement methodology was used to develop high-impact interventions that led to dramatically improved adherence to the Surviving Sepsis Campaign guidelines bundle. Improved performance was associated with a significant decrease in the in-hospital mortality of severe sepsis patients presenting to the emergency department.

Multidisciplinary Sepsis and Shock Response Team Improves Quality of Care Measures and Clinical Outcomes

Multidisciplinary Sepsis and Shock Response Team Improves Quality of Care Measures and Clinical Outcomes

Evaluation of Process Variations in Noncompliance in the Implementation of Evidence-Based Sepsis Care

Sepsis is recognized as an often-lethal disease. Recommended guidelines are complex and time sensitive. Response teams (RTs) have demonstrated success in implementation of quality initiatives. The purpose of this study was to evaluate variations in noncompliance with recommended sepsis guidelines overall and between a sepsis-focused RT and standard care. This retrospective chart review categorized septic patients based on treatment by a sepsis response team (SRT) versus standard care (non-SRT). Guideline compliance was based upon the Surviving Sepsis evaluation and treatment guidelines. Patient records for 123 identified septic patients post first-year implementation were evaluated. Overall, compliance rates were low and there were variations in compliance between the treatment providers. The SRT was more compliant than the non-SRT. SRT noncompliance was more often due to failure to achieve therapeutic goals within the recommended time. Mortality benefit was not statistically significant between groups; however mortality was higher in the non-SRT group. Noncompliance is more complex than simple failure to initiate, especially in time-dependent therapies. The development and education of an RT demonstrates improvement in application of sepsis-focused therapies over standard care.

Septic shock: A multidisciplinary response team and weekly feedback to clinicians improve the process of care and mortality*

To evaluate the impact of weekly feedback to clinicians and the activation of a sepsis response team on the process of care and hospital mortality in patients with severe sepsis or septic shock. Prospective, interventional cohort study. The medical intensive care unit of a tertiary, academic medical center. Patients with severe sepsis or septic shock consecutively treated in a medical intensive care unit. Daily auditing and weekly feedback, and sepsis response team activation. During a 33-month study period, from January 2007 through September 2009, we performed daily screening of patients for severe sepsis or septic shock. Study periods were divided into baseline (screening only), daily auditing with weekly feedback, and sepsis response team activation. Comparisons among the three periods were made by using univariate and multiple logistic regression analyses. Compliance with the overall sepsis resuscitation bundle and its individual elements and hospital mortality were used as outcome measures. A total of 984 episodes of severe sepsis and septic shock were identified during the study periods, severe sepsis in 52 (5.3%) and septic shock in 932 (94.7%). The compliance rate with all elements of the sepsis resuscitation bundle increased from 12.7% at baseline to 37.7% and 53.7% during the weekly feedback and sepsis response team activation periods, respectively (p < .001). Overall hospital mortality rate was 30.3%, 28.3%, and 22.0% during baseline, weekly feedback, and sepsis response team periods, respectively (p = .029). Multiple logistic regression analysis showed that the sepsis response team was associated with reduced risk of hospital death (odds ratio, 0.657; 95% confidence interval, 0.456-0.945; p = .023) whereas hepatic cirrhosis, hepatic failure, leukemia, multiple myeloma, transfer from the same hospital ward, do-not-resuscitate status at the recognition of severe sepsis/septic shock, and lactate level were associated with increased risk of death. In septic shock, the activation of the sepsis response team in combination with weekly feedback increases the compliance with the process of care and reduces hospital mortality rate.

Early Goal-Directed Therapy: Improving Mortality and Morbidity of Sepsis in the Emergency Department

The growing number of patients with severe sepsis or septic shock and the resulting mortality rate (30%) require changes in the current protocols used to treat these conditions. Through adaptation of early goal-directed therapy (EGDT), Carolinas Medical Center developed a process improvement strategy for decreasing mortality associated with severe sepsis and septic shock. Before implementing the EDGT protocol, the ED did not follow a written management protocol for septic patients. Following establishment of an interdisciplinary team, several process improvement activities were conducted, including the development of a standardized algorithm and treatment protocol, a physician order sheet, a nursing flow sheet, and a code sepsis response team. A total of 381 patients were enrolled: 79 in the pre-intervention phase and 302 in the postintervention phase. Mortality rates decreased from 27% pre-intervention to 19% postintervention (-8% absolute mortality; 95% confidence interval [C.I.], 7-9; p = .2138). There were significant differences between the pre- and postintervention groups for endotracheal intubation (17%, p = .0012), crystalloid infusion (1.4 L, p < .0001), vasopressor administration (33%, p < .0001), and packed red blood cells (34%, p < .0001). Both groups were generally similar in their demographics, comorbidities, and vital signs. As a result of this process improvement initiative, patients who might have received delayed and/or inadequate treatment for severe sepsis or septic shock are now receiving effective, life-saving treatment. Because of the emphasis on training, consistency in applying the protocol, relatively few changes in current ED practice, and low direct expenditures for equipment, the protocol can be easily integrated into existing ED environments to allow hospitals to quickly implement this successful, best-practice program.