Administrators at the University of Arkansas for Medical Sciences (UAMS), a Level 1 trauma center in Little Rock, were concerned to learn that the facility’s risk-adjusted mortality index for patients diagnosed with sepsis was significantly higher than other top academic medical centers, with a baseline rate of 25.124% from October 2020 through September 2021. More than half of the patients who died after being admitted to the hospital had sepsis.
Hospital leadership recognized the need to create a sepsis diagnosis and treatment standard for clinical staff to use consistently throughout the facility. Their first action was to establish a sepsis quality improvement team co-led by a critical care physician, a medical-surgical nursing director and a process improvement analyst. The team also engaged as many departments as possible, including provider and nursing leaders across critical care, medical surgical, infectious disease, emergency medicine and cancer divisions as well as staff from pharmacy, quality, information systems and clinical documentation.
“Senior leadership, such as the chief compliance officer and chief nursing officer, were engaged in highlighting the importance of this work and in keeping up momentum,” said Robbie Hemmer, MHA, BSN, BBA, RN, director of quality for UAMS.
The sepsis team expanded upon the facility’s existing emergency room sepsis workflow process to create an inpatient clinical pathway for timely identification and treatment of sepsis. UAMS implemented the new standard in November 2021 and achieved a 20.74% relative improvement rate in its 30-day sepsis mortality rate from baseline to Year 2.
Specifically, the interventions outlined in the UAMS Inpatient Sepsis Pathway include:
- Creating a new Best Practice Alert (BPA) for nurses and providers if patient's Risk of Sepsis score reached a designated threshold
- Nurse was responsible for notifying the provider about any change in sepsis variables
- was responsible for evaluating patient and activating the sepsis order set
- Developing sepsis order set, which outlined evidence-based treatment protocols for labs, fluids, medications, nursing tasks and other orders
- Prioritizing open and effective communication between providers, nurses and leadership regarding the patient's treatment using the sepsis clinical pathway
- Engaging physician leadership to highlight importance of the sepsis clinical pathway across services and provider groups
- Tasking physician leadership to review and take appropriate follow-up actions based on performance on process measures.
“Open and effective communication between providers, nurses and leadership regarding the patient’s journey along the sepsis clinical pathway became the standard,” Hemmer explained. “Whereas the nurse may have noticed sepsis-type symptoms in the past but didn’t think the symptoms were enough to ‘bother’ the provider, the expectation was established that the nurse inform the provider of any new or changed sepsis variables.”
A TMF quality improvement specialist provided support to UAMS through frequent virtual check-ins to assess progress and share quality improvement tools, including the Process Improvement Discovery Tool and Sepsis Mortality Reduction Top Ten Checklist.
“Early identification of sepsis is key to improved patient outcomes,” shared Hemmer. “Standard and open communication between providers and nurses, and providers with other providers, is key to a successful rollout of a clinical pathway.”
Click here to view the UAMS Inpatient Sepsis Pathway