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Reducing Sepsis-Related Death: A Ripple of Success
The success of the Surviving Sepsis Campaign (SSC) has begun to ripple through hospitals of all sizes, resulting in earlier detection of septic patients and improved patient outcomes worldwide. This success has spread through the Iowa Health System where the campaign has been implemented in all 11 of its hospitals, with the goal of significantly lowering mortality rates in their respective communities.
This massive undertaking began with the efforts of the staff at St. Luke’s Hospital in Cedar Rapids, Iowa. St. Luke’s is a full-service, 560-bed hospital with a 14-bed intensive care unit (ICU). In 2004, the hospital began to roll out a long-term plan for healthcare quality that involved the implementation of a multiprofessional team of professionals led by an intensivist and the use of daily goal sheets (DGS). The ventilator bundles also were introduced with a goal of reducing the incidence of ventilator-associated pneumonia (VAP) to zero. It was through these initiatives that members of the hospital team learned about the SSC. They determined that implementing the sepsis bundles would be the next natural step in their quality plan.
By spring 2006, the St. Luke’s multiprofessional ICU team was rounding daily, using DGS effectively and had reduced VAP to nearly zero. It was time to move to the next step, but the staff knew that implementing the SSC would be a challenge. It involved more protocols than the VAP initiative, demanded more time from staff and required streamlined processes. Physicians had been taking some steps to identify and treat septic patients, but needed help bringing the team together.
“We recognized this was very big, and we wanted to do it right,” said St. Luke’s critical care medical director James Boddicker, MD. “We thought ‘why not learn from the experts?’”
That led them to the SSC regional training program. Jill Morgan, RN, MBA, director of St. Luke’s adult ICU, contacted the Society of Critical Care Medicine (SCCM) to express interest its sepsis regional training program. Steve Simpson, MD, and Carol Cleek, RN, MSN, CCRN, both from the University of Kansas Medical Center, along with Sean Townsend, MD, from the SSC Executive Committee, traveled to Iowa in August to conduct an SSC workshop.
Earlier in the year, the Kansas duo had participated in a faculty preparation program for physicians and nurses familiar with sepsis treatment. Key leaders of the campaign specially invited participants like Simpson and Cleek, who have the background necessary to educate others about campaign implementation.
St. Luke’s sent several members from its emergency department (ED), cardiac care unit, ICU and medical emergency team staff, as well as quality leaders and administrators, to the regional training session. During the session, participants were provided with the tools necessary to return to their hospitals and implement the campaign according to their own policies and procedures. They learned about the campaign’s recommended six- and 24-hour bundles, process improvement strategies, team building and the performance improvement database, which is the heart of bedside clinical improvement.
Creating Two Fronts
St. Luke’s staff wasted no time in mapping their strategy to implement the campaign and created an organized plan of action the day after the regional training session. They organized two teams: a steering committee to develop protocols and procedures, and a frontline team charged with evaluating the effectiveness of the procedures and reporting back to the steering committee. They developed and approved a sepsis order set and a screening tool, placing both on the hospital’s Intranet so all staff could access the information easily.
“It has to be team effort. The frontline team members are going to be the ones interacting to make this happen,” Boddicker said. “It also helps break down the interdepartment biases.” New procedures were developed to streamline the ICU lab and pharmacy and to ensure that members of the ICU and emergency department staff were following the same sepsis evaluations. Because so many patients present in the ED with sepsis, it is a critical frontline intervention point. Starting the six-hour bundles there can help produce better patient outcomes, and working closely with the ICU staff helps keep ICU beds open so patients can be treated in a more comprehensive fashion. Members of St. Luke’s ICU and emergency teams have worked together since the beginning of the initiative to ensure better communication between the departments.
Gretchen Aschoff, St. Luke’s performance improvement advisor, was charged with collecting baseline data and managing the SSC database. Aschoff also was added to the team of multiprofessionals rounding daily to ensure that patient data could be evaluated concurrently rather than retrospectively. Recording and entering data into the SSC database is vital to the team’s success, as it allows hospital staff to analyze their own performance with the bundles and to benchmark it against similar hospitals. The hospital also has committed to transmitting their de-identified data to the SSC database to assist the campaign in collecting aggregate data for outcomes reporting. This important step bonds St. Luke’s and the Iowa Health System with a larger worldwide community of clinicians who are committed to the campaign’s goals. Transmission of data is secure and easy, so it adds no additional burden on the data collector. The SSC database is supported by a manager for those who need help with installation and report generation.
The Ripple Continues
While St. Luke’s staff took the first steps to implement the campaign, the entire Iowa Health System kicked off an effort to use the campaign bundles in all of its hospitals in January. Hospitals within the system range from large urban facilities like St. Luke’s to rural hospitals serving small
populations. Each hospital brings a different spectrum of resources and available workforce, but everyone is dedicated to the campaign’s cause.
During the kick off, Simpson and Cleek traveled back to Iowa to host several presentations, and representatives from St. Luke’s displayed a storyboard detailing their route to success. The SSC offers assistance beyond the regional training program, including open invitations to discussion groups and teleconferences that give participants direct access to senior leadership within the campaign.
Embracing evidence-based medicine and encouraging protocol adherence will not only save lives, but also likely will reduce hospital costs. It often also results in an improved team environment and better department collaboration. The Iowa Health System’s efforts represent one slice of the SSC’s initiative to reduce sepsis-related mortality rates by 25% worldwide by 2009. Once St. Luke’s team reaches its goals, the success of the SSC likely will branch out into the surrounding area outside the health system. Leaders plan to collaborate with other hospitals that participated in the regional training program and spread their knowledge. For now, the Iowa Health System is concentrating on educating the staff about the sepsis bundles, recording data and reaching goals. In the spirit of the Right Care, Right NowTM message stressed by the Society, Boddicker reminds and encourages his staff to treat “every patient right, every day, 100% of the time.
