Facing Challenges and Producing Results
Surviving Sepsis Campaign Data Summits Continue to Cultivate Success
The Society of Critical Care Medicine, working with leaders of the Surviving Sepsis Campaign (SSC), recently held two Surviving Sepsis Campaign North American Summits as part of a groundbreaking effort to enhance the efforts of hospitals and hospital networks striving to improve sepsis care through collaboration
and teamwork.
The summits were organized as a series of workshops and networking opportunities among interested hospitals that have implemented the Campaign’s software-based performance improvement program and have begun collecting data. Collecting and reporting data to the SSC are vital components of an institution’s progress improvement program, allowing the hospital to review and evaluate performance and help staff set and achieve goals. When data are reported to the Campaign, they can be evaluated to assess the success of the SSC in changing practice (process change) and to benchmark that change against other participating hospitals. Two different U.S. summit groups have been established, on the east and west ends of the United States, to share data and identify their areas of progress and difficulty, as well as to assess “tricks of the trade” from national experts in sepsis management change process. The western summit was held in November 2007 with representatives from 23 hospitals gathering in Denver, Colorado, for a full day of data sharing and hands-on workshops led by expert faculty. Among the participants in this most recent summit were members of the Colorado Critical Care Collaborative, which has been working on improvement in sepsis care for more than two years. In addition, clinicians from the Kansas and Arizona statewide critical care collaboratives were present to share experiences and take back information to their colleagues.
Campaign leaders addressed improving performance in three key areas previously identified as the most challenging:
• Earlier diagnosis of sepsis
• More rapid antibiotic administration
• Achieving ScvO2 and central venous pressure targets in sepsis-induced tissue hypoperfusion
Developing Strategies that Work
An improvement advisor for the Institute of Healthcare Improvement (IHI), Jane Taylor, EdD, discussed the power of the IHI’s Plan-Do-Study-Act cycle in achieving optimal results in these areas and in implementing change overall. She worked with individual hospitals and groups to help participants identify their goals, identify changes needed achieve those goals, and assess an implementation plan. Participants formed small groups and were encouraged to learn from each other through storyboards that outlined each hospital’s data as well as the challenges and successes of the institution’s process change. “We encourage small groups to share data openly to foster collaboration,” Taylor explained. “Participants get peer consultation on the spot.”
Expert faculty also were on hand, including R. Phillip Dellinger, MD, FCCM, Mitchell Levy, MD, FCCM, Sean Townsend, MD, Christa Schorr, BSN, CCRN, Ronald Rains, MD, and Ivor Douglas, MD. These facilitators helped each hospital develop plans of action for improvement specific to their needs and resources.
Bringing Valuable Lessons Home
Engaging the emergency department in the SSC and bringing knowledge to the front lines were common challenges expressed by summit participants, and faculty identified these as some of the most vital issues related to Campaign success. Despite challenges, effectively bringing the emergency department staff into the collaboration is essential.
Heidi Nelson, RRT, MHS, from University Hospital in Georgia, said the summit she attended earlier in the year in Miami, Florida, was a unique learning experience that helped hospital staff renew their SSC initiatives. Nelson reported that many of the lessons learned during the summit were incorporated into lunch-and-learn sessions focused on educating frontline staff about the importance of sepsis identification and resuscitation bundles and on offering tips for implementation. In addition to these valuable sessions, the emergency department also plans to implement a bundle to screen for patients at risk for pneumonia and sepsis. This sepsis-pneumonia profile was created after data analyses showed that a high percentage of the hospital’s pneumonia patients became septic.
Nelson also was impressed by the sense of teamwork and open communication within the meeting. “I’ve been in contact with many of my counterparts from the summit and stayed in touch,” Nelson said. “We learned we have a lot in common as far as challenges, but we also picked up a lot of simple strategies – things you could implement the next day.”
Taylor said she was happy that so many hospitals were able to take away simple ideas for change. Identifying simple strategies and then testing them on a small scale are vital when implementing a program like the SSC. “If your ideas about what you want to implement are wrong or if you forget something … it’s very costly to go back in terms of time, support and resources,” she said. “We stress that participants should learn their way through to results with small steps of change.”
Anjetta Atkins, RN, BSN, travelled from Scott & White Hospital in Texas to participate in the Denver summit. “It was a good opportunity to see what other hospitals were doing,” she said. Since the summit, the hospital has begun looking into several options for identifying and managing sepsis earlier. Ideas have included adding a respiratory therapist to multiprofessional rounds and enlisting the help of the rapid response team to assist the emergency department nurses in identifying septic patients early. “I understand the importance of baby steps,” she said. “We want to make sure the changes are lasting.”
Continuing Teamwork
Each summit collaborative is scheduled to meet for two in-person meetings and two Webinars over a six-month period to demonstrate that rapid-cycle change in sepsis care can reduce mortality. The Society hopes this model will encourage long-term collaboration and help build lasting relationships among participating hospitals. These participants then may act as mentors for other hospitals looking to implement the Campaign, improve their results or build on their successes. The SSC summits attracted a varied group of participants with a range of clinical expertise, backgrounds and resources. Some are employed at university hospitals, while others hail from small community hospitals. Participants came from a variety of states including Florida, Georgia, Virginia, Maryland, Indiana, North Carolina, Kansas, Michigan, Colorado, Washington, Tennessee, Nevada, Texas, Arizona, New Jersey, Alabama, Wyoming and Iowa.
The diverse audience created a strong team atmosphere where every participant could bring new ideas and perspectives. The summits also give faculty the opportunity to learn from those on the front lines of the Campaign, as the SSC leaders are able to hear personal stories and feedback.
The SSC continues to capture the interest and participation of hospitals around the globe, furthering its goal to reduce the mortality rate associated with sepsis by 25% in five years. Internationally 12,572 severe sepsis patients have been entered in the SSC central performance improvement database (240 hospitals in 17 countries) with 6,238 of these entered by hospitals in the United States. The initial analyses for process change and effect on outcome will be performed in May 2008. The Society will continue to offer innovative ways to further the goals of the Campaign as part of its own mission to improve the overall care of critically ill and injured patients.
