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Original research
Strengthening sepsis care at a tertiary care teaching hospital in New Delhi, India
  1. Charu Malhotra1,
  2. Akshay Kumar1,
  3. Ankit Kumar Sahu1,
  4. Akshaya Ramaswami1,
  5. Sanjeev Bhoi1,
  6. Praveen Aggarwal1,
  7. Rakesh Lodha2,
  8. Arti Kapil3,
  9. Sonali Vaid4,
  10. Nitesh Joshi1
  1. 1Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
  2. 2Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
  3. 3Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
  4. 4Incluve Labs LLP, New Delhi, India
  1. Correspondence to Dr Akshay Kumar; akshay2111{at}gmail.com

Abstract

Introduction Failure of early identification of sepsis in the emergency department (ED) leads to significant delays in antibiotic administration which adversely affects patient outcomes.

Aim The primary objective of our Quality Improvement (QI) project was to reduce the door-to-antibiotic time (DTAT) by 30% from the preintervention in patients with suspected sepsis. Secondary objectives were to increase the blood culture collection rate by 30% from preintervention, investigate the predictors of improving DTAT and study the effect of these interventions on 24-hour in-hospital mortality.

Methods This QI project was conducted in the ED of a tertiary care teaching hospital of North India; the ED receives approximately 400 patients per day. Adult patients with suspected sepsis presenting to our ED were included in the study, between January 2019 and December 2020. The study was divided into three phases; preintervention phase (100 patients), intervention phase (100 patients) and postintervention phase (93 patients). DTAT and blood cultures prior to antibiotic administration was recorded for all patients. Blood culture yield and 24-hour in-hospital mortality were also recorded using standard data templates. Change ideas planned by the Sepsis QI Team were implemented after conducting plan-do-study-act cycles.

Results The median DTAT reduced from 155 min in preintervention phase to 78 min in postintervention phase. Drawing of blood cultures prior to antibiotic administration improved by 67%. Application of novel screening tool at triage was found to be an independent predictor of reduced DTAT.

Conclusion Our QI project identified the existing lacunae in implementation of the sepsis bundle which were dealt with in a stepwise manner. The sepsis screening tool and on-site training improved care of patients with sepsis. A similar approach can be used to deal with complex quality issues in other high-volume low-resource settings.

  • control charts/run charts
  • emergency department
  • quality improvement
  • sepsis
  • PDSA

Data availability statement

Data are available on reasonable request. Data are available on reasonable request to the corresponding author.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjoq-2020-001335

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    Data availability statement

    Data are available on reasonable request. Data are available on reasonable request to the corresponding author.

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    Footnotes

    • Twitter @sonalivaid

    • Contributors Study planning: CM, AKu, SB, PA, RL and AKa. Study conduct: CM, AKu, SV and NJ. Data collection: CM. Data analysis: AKS and CM. Manuscript writing: CM and AR. Proofreading: CM, AKu, SB, PA, RL, AKa and AR.

    • Funding Publication of this article is made Open Access with funding from the Nationwide Quality of Care Network.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.