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Successful prospective quality improvement programme for the identification and management of patients at risk of sepsis in hospital

OBJECTIVE: This audit aimed to improve the speed and completeness of delivery of treatment to urology patients at risk of sepsis in the hospital. PATIENTS AND METHODS: Patients were prospectively included if they developed a new-onset systemic inflammatory response syndrome, were reviewed by a docto...

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Autores principales: Gallagher, Kevin, Blackwell, Nicky, Thomas, Ben, Trail, Matthew, Stewart, Lorraine, Paterson, Ross
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567954/
https://www.ncbi.nlm.nih.gov/pubmed/31259273
http://dx.doi.org/10.1136/bmjoq-2018-000369
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author Gallagher, Kevin
Blackwell, Nicky
Thomas, Ben
Trail, Matthew
Stewart, Lorraine
Paterson, Ross
author_facet Gallagher, Kevin
Blackwell, Nicky
Thomas, Ben
Trail, Matthew
Stewart, Lorraine
Paterson, Ross
author_sort Gallagher, Kevin
collection PubMed
description OBJECTIVE: This audit aimed to improve the speed and completeness of delivery of treatment to urology patients at risk of sepsis in the hospital. PATIENTS AND METHODS: Patients were prospectively included if they developed a new-onset systemic inflammatory response syndrome, were reviewed by a doctor who thought this was due to infection and prescribed antibiotics. We measured median time to antibiotic administration (TTABx) as the primary outcome. Factors associated with delays in management were identified, targeted quality improvement interventions implemented and then reaudited. RESULTS: There were 74 patients in the baseline cohort and 69 following interventions. Median TTABx fell from 3.6 (1.9–6.9) hours to 1.7 (1.0–3.8) p<0.001 hours after interventions. In the baseline cohort, factors significantly associated with a delay in TTABx were: an Early Warning Score less than the medical review trigger level; a temperature less than 38°C; having had surgery versus not. Interventions included: reduced medical review trigger thresholds, education sessions, communication aids, a department-specific sepsis protocol. There were significant improvements in the speed and completeness of sepsis management. Improvements were most marked in postoperative patients. Improvement longevity was achieved through continued work by permanent ward nurse practitioners. CONCLUSION: A period of baseline prospective study, followed by tailored quality improvement initiatives, can significantly improve the speed and quality of sepsis management for inpatients on an acute hospital ward.
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spelling pubmed-65679542019-06-28 Successful prospective quality improvement programme for the identification and management of patients at risk of sepsis in hospital Gallagher, Kevin Blackwell, Nicky Thomas, Ben Trail, Matthew Stewart, Lorraine Paterson, Ross BMJ Open Qual BMJ Quality Improvement report OBJECTIVE: This audit aimed to improve the speed and completeness of delivery of treatment to urology patients at risk of sepsis in the hospital. PATIENTS AND METHODS: Patients were prospectively included if they developed a new-onset systemic inflammatory response syndrome, were reviewed by a doctor who thought this was due to infection and prescribed antibiotics. We measured median time to antibiotic administration (TTABx) as the primary outcome. Factors associated with delays in management were identified, targeted quality improvement interventions implemented and then reaudited. RESULTS: There were 74 patients in the baseline cohort and 69 following interventions. Median TTABx fell from 3.6 (1.9–6.9) hours to 1.7 (1.0–3.8) p<0.001 hours after interventions. In the baseline cohort, factors significantly associated with a delay in TTABx were: an Early Warning Score less than the medical review trigger level; a temperature less than 38°C; having had surgery versus not. Interventions included: reduced medical review trigger thresholds, education sessions, communication aids, a department-specific sepsis protocol. There were significant improvements in the speed and completeness of sepsis management. Improvements were most marked in postoperative patients. Improvement longevity was achieved through continued work by permanent ward nurse practitioners. CONCLUSION: A period of baseline prospective study, followed by tailored quality improvement initiatives, can significantly improve the speed and quality of sepsis management for inpatients on an acute hospital ward. BMJ Publishing Group 2019-06-12 /pmc/articles/PMC6567954/ /pubmed/31259273 http://dx.doi.org/10.1136/bmjoq-2018-000369 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle BMJ Quality Improvement report
Gallagher, Kevin
Blackwell, Nicky
Thomas, Ben
Trail, Matthew
Stewart, Lorraine
Paterson, Ross
Successful prospective quality improvement programme for the identification and management of patients at risk of sepsis in hospital
title Successful prospective quality improvement programme for the identification and management of patients at risk of sepsis in hospital
title_full Successful prospective quality improvement programme for the identification and management of patients at risk of sepsis in hospital
title_fullStr Successful prospective quality improvement programme for the identification and management of patients at risk of sepsis in hospital
title_full_unstemmed Successful prospective quality improvement programme for the identification and management of patients at risk of sepsis in hospital
title_short Successful prospective quality improvement programme for the identification and management of patients at risk of sepsis in hospital
title_sort successful prospective quality improvement programme for the identification and management of patients at risk of sepsis in hospital
topic BMJ Quality Improvement report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567954/
https://www.ncbi.nlm.nih.gov/pubmed/31259273
http://dx.doi.org/10.1136/bmjoq-2018-000369
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