546 Implementing an effective code sepsis process to save lives for septic shock

Document Type

Conference Proceeding

Publication Date

5-13-2024

Publication Title

Acad Emerg Med

Abstract

Background and Objectives: Sepsis afflicts 1.7?million Americans annually. Implementation of sepsis bundles across health care systems is complex and challenging. The aim was to leverage the consolidated framework for implementation research (CFIR) for effective implementation of a code sepsis response team for patients identified at risk of having severe sepsis or septic shock, across a health system of mixed academic and community practices. Methods: Henry Ford Health (HFH) includes 5 hospitals (Level I, II, and III trauma centers). The volume of severe sepsis and septic shock patients ranges between 28 and 62 per month. Description: The HFH sepsis program identified gaps and explored barriers and facilitators of compliance to an existing code sepsis policy. This informed a 2022 codes sepsis re-design project which included revision of the policy, enhancement to the electronic sepsis narrator tool, and an implementation strategy focused on leadership engagement, resources, access to knowledge and information, implementation checklists and tools (flyers, visual aids, educational videos and modules etc.). Each hospital received guidance on adaptation for local needs. Implementation occurred in the final quarter of 2022. Evaluation: Quasi-experimental pre- and post-implementation analysis of adult patients >18?years of age, presenting to HFH EDs with diagnoses of severe sepsis and septic shock, excluding those with diagnosis of COVID-19, transfers in, and patients discharged to hospice. Pre-implementation phase: Jan. – Sep. 2022 and post implementation phase: Jan. – Sep. 2023. Primary outcome is septic shock mortality and secondary outcome is proxy 3-h bundle compliance. Descriptive stats were calculated with a series of mortality samples and a two sample t test was performed to compare the two populations. Utilized SPC for excel. Results: Septic shock mortality in the pre-implementation phase was 27.0% and post implementation phase 21.7% (difference of 5.36%, p?=?0.004). Proxy 3-h bundle compliance improved from 71.2% to 74.0% (difference –2.80%, p?=?0.05). Conclusion: Delivery of sepsis bundles is complicated, especially across large health care systems with hospitals of varying practice models. Implementation strategies can be designed to achieve system goals while incorporating the needs and resource considerations of local hospitals to reduce sepsis mortality.

Volume

31

Issue

S1

First Page

257

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