Hospital Sepsis Detection and Management Program Associated with Lower Inpatient Death Rates, Costs

Joint Commission Resources, Inc. today released the November 2015 issue of the Joint Commission Journal on Quality and Patient Safety, featuring an article on how Houston Methodist Hospital (HMH) in Houston, Texas, prioritized sepsis detection and management in its intensive care unit (ICU) to decrease inpatient death rates and costs.

The article, “Reductions in Sepsis Mortality and Costs After Design and Implementation of a Nurse-Based Early Recognition and Response Program," by Stephen L. Jones, MD, MSHI, and colleagues, highlights the development of the HMH sepsis program, first implemented in 2009. Designed to be readily used by nurses, the sepsis program helped with the early recognition of patients showing signs of possible infection, as well as the institution of prompt, evidence-based interventions to diagnose and treat it.

The interventions consisted of four components: organizational commitment and data-based leadership; development and integration of an early sepsis screening tool into the electronic health record; creation of screening and response protocols; and education and training of nurses. In addition, twice-daily screenings of patients on targeted units were conducted by bedside nurses, and nurse practitioners initiated definitive treatment as indicated.

By the third year of the sepsis program (2011), 33 percent of inpatients were screened, up from 10 percent in the first year. Inpatient sepsis-associated death rates decreased from 29.7 percent in the pre-implementation period (2006–2008) to 21.1 percent after implementation (2009–2014). Death rates and hospital costs for Medicare beneficiaries also decreased from pre-implementation levels.

The authors state that their program’s unique factors are “its focus on all inpatients, not just patients in the ICU; the goal of identifying sepsis early, before it progresses to severe sepsis and septic shock; the fact that nurses are the frontline implementers of screening and response protocols; the intensive simulation training that second-responder nurses undergo; and the seamless integration of the screening tool into the hospital’s electronic data and information systems supporting bedside patient care.”

Source: Joint Commission Resources, Inc.