Table 5

Needs assessment findings and suggested interventions by framework level*7

Framework levelNeeds assessment findingsInterventions
Level 7, population healthSEP-1 national compliance is 51%22This level is beyond the scope of this QI initiative which is organisation specific
Level 6, patient healthSEP-1 institutional compliance is 19%22The QI project strives to improve outcomes at this level by addressing levels 3–5
Level 5, clinician performanceChart 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

  • 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, satisfactionNot 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, participationNot 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.