Surviving Sepsis

Sepsis is a major threat to hospitalized patients. As the leading cause of hospital mortality, medical professionals need to be on alert for the signs of sepsis. At Baylor University Hospital in Dallas, a nurse-driven sepsis protocol has made major strides in reducing sepsis infection rates.

The hospital began looking at sepsis interventions back in 2013. “Sepsis screening is pretty much the same wherever you go,” explained John Garrett, MD, associate medical director, Department of Emergency Medicine. Sepsis screening tests consist of serum lactate, complete metabolic panels and complete blood count with differential.

Screening Elements
In the Baylor University Hospital Adult Sepsis Screen & Treatment Algorithm, every emergency department patient is screened for sepsis. “The way we screen these patients is constantly evolving,” Garrett said, “A major driver of improvement is early detection and early antibiotics.”

Two SIRS criteria equal a positive screen. These include, a heart rate of less than 90; systolic blood pressure greater than 90; mean blood pressure greater than 65; body temperature less than 96.8 F or greater than 100.5 F; and a respiratory rate of less than 20, The hospital looked at the CDC’s Surviving Sepsis guidelines as a starting point but Garrett said, “We wanted to hold ourselves to stricter goals.”

This process had typically been physician-lead, which is what makes the Baylor system stand out. Typically, if a patient screened positive, the nurse would call the doctor and the doctor would order the lab tests. “We focused our attention on empowering nurses to order labs without waiting for a doctor,” Garrett said. “We do this with trauma patients, stroke patients, heart attack patients, etc.,” he explained.

Since an ED nurse is often a patient’s first point of contact, having a nurse-driven screening process shaves off time. With sepsis cases, the quicker antibiotics can be administered, the better the chance of survival.

Working in Tandem
They also worked to expedite lab results to identify occult sepsis cases, ones that Garrett defined as “hidden cases where patient looks good but are still pretty sick.” This was accomplished through the teamwork of different disciplines on the ED. A multidisciplinary team of clerks, lab techs, nurses, physicians, and other healthcare workers went through the process of patient check-ins. They identified areas with wasted opportunities and efforts to create a more streamlined process, cutting the fat.

The protocol “takes a team of four or five people working in conjunction,” said Garrett. With emergency department patients who are team triaged, that is the physician and nurse co-triage and the ED physician decides who gets the sepsis protocol. If the nurse triages solo, she decides who

Staff nurses, the charge nurse, the lab tech, the pharmacist and the physician accomplish the process very rapidly. Built-in redundancies ensure that if one part of the process doesn’t work, it will be covered for elsewhere.

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Saving Lives
Baylor University Hospital’s efforts have paid off. Garrett said, “We really save lives doing this.” Since the nurse-driven sepsis screening program began two years ago, the median time from a patient’s triage e to when they received antibiotics for sepsis dropped from 153 minutes to 70-80 minutes. The new system lets the clinicians recognize sepsis patients much faster to expedite treatment. As a result, the hospital has experienced a 50% drop in sepsis mortality. Real-time feedback to providers showing both positive and negative results has been invaluable.

Although this process started at Baylor University Hospital, it has spread to the other emergency department in the healthcare system.

Danielle Bullen is on staff at ADVANCE. Contact: dbullen@advanceweb.com.

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