Table 5

Needs assessment findings and suggested interventions by framework level*7

Framework level	Needs assessment findings	Interventions
Level 7, population health	SEP-1 national compliance is 51%22	This level is beyond the scope of this QI initiative which is organisation specific
Level 6, patient health	SEP-1 institutional compliance is 19%22	The QI project strives to improve outcomes at this level by addressing levels 3–5
Level 5, clinician performance	Chart review findings: The most frequently missed elements: The initiation and administration of IVF within a specified time Repeat lactate level collection Documentation of repeat volume and tissue perfusion assessment Administration of broad-spectrum antibiotics	Clinician point-of-care reminders or prompts; and performance measurement and feedback of patient care data
Level 4, competence†	Focus group findings: No comments on competence Unclear if a gap exists; additional data collection warranted	Simulation activities: Predisposing activities‡: Simulation to assess the integration of knowledge Enabling activities‡: Simulation to establish and extend competence Reinforcing‡: Periodical simulation activities to reinforce competence Reflection on commitment to change
Level 3, learning: dispositional knowledge†	Focus group findings: Providers are not inclined to use order sets due to repetitive orders	Educational meetings Predisposing activities: Discuss with participants sharing poignant examples of the impact of sepsis on patients and how the SEP-1 bundle improves care Share aggregate data on performance gaps, with peer and benchmark comparisons where available Enabling activities: Reinforce the impact of SEP-1 bundle during presentations and worked examples Reinforcing activities: Send follow-up newsletters sharing stories that correlate bundle compliance with successful patient outcomes
Level 3, learning: procedural knowledge†	Focus group findings: No comments on procedural knowledge Unclear if a gap exists; additional data collection warranted	Educational workshops Predisposing activities based on identified needs: Email that includes a review of material from prior meetings and new material for the workshop Pretest on procedural knowledge Enabling activities: Presentations that illustrate the performance gap Worked examples that model step-by-step performance goals Deliberate practice, working through case examples and solidifying skills Reinforcing activities: Expert feedback with coaching
Level 3, learning: declarative knowledge†	Focus group findings: Participants are unaware of the following bundle components: Timing for the repeat lactate level Use of IBW for IVF administration Repeat volume assessment and tissue perfusion documentation The EHR documentation aids: smart phrase text	Educational meeting Predisposing activities: Pretest on SEP-1 bundle components Enabling activities: Explanation of the SEP-1 bundle Small group work on representative sepsis cases Reinforcing activities: Follow-up email to participants summarising key points of the session and providing additional education resources
Level 2, satisfaction	Not applicable to the needs assessment Participants will have an opportunity to provide feedback on their learning experiences on each activity	Provide well-constructed, well-organised and appropriate activities in a comfortable environment, and assess participant satisfaction
Level 1, participation	Not applicable to this needs assessment Educators will track participation with all activities	Participant recruitment: Email intermittent reports that highlight performance gaps Announce SEP-1 educational opportunities at other educational offerings

*Educational interventions are suggestions in the context of the conceptual outcomes framework.7
†Data gathered during the educational sessions are used formatively. These new data will be used to evaluate additional performance gaps and to inform the content of the educational interventions.
‡Predisposing, enabling and reinforcing activities from the conceptual outcomes framework are strategies to organise educational activities.
EHR, electronic health record; IBW, ideal body weight; IVF, intravenous fluid; QI, quality improvement; SEP-1, Centers for Medicare and Medicaid Services quality bundle for management of patients with severe sepsis and septic shock.