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Successful prospective quality improvement programme for the identification and management of patients at risk of sepsis in hospital
  1. Kevin Gallagher1,2,
  2. Nicky Blackwell2,
  3. Ben Thomas2,
  4. Matthew Trail2,
  5. Lorraine Stewart2,
  6. Ross Paterson3
  1. 1Department of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
  2. 2Department of Urology, Western General Hospital, Edinburgh, UK
  3. 3Department of Critical Care, Western General Hospital, Edinburgh, UK
  1. Correspondence to Dr Kevin Gallagher; kevin.mjgallagher{at}gmail.com

Abstract

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.

  • patient safety
  • healthcare quality improvement
  • hospital medicine
  • quality improvement
  • sepsis

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/.

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Footnotes

  • Contributors KG wrote the manuscript and is responsible for the overall content. KG and NB conceived, designed, collected data, analysed data and reviewed manuscript. BT and RP conceived and designed the study, reviewed data and reviewed the manuscript. MT and LS collected data and reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. KG was funded by the Medical Research Council UK, Kidney Research UK and GlaxoSmithKline for an un-related project during preparation of this manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

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