Implementing the Surviving Sepsis Campaign

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1 Implementing the Surviving Sepsis Campaign Lessons learned and data shared Shore Health System University of Maryland Medical System UMMS Sepsis Task Force Timeline Sepsis identified as issue for mortality at Dorchester Started UMMS system task force for sepsis Severe sepsis mortality rate below target Join UMMS July 2006 Jan 2007 Jul 2007 Jan 2008 Jul 2008 Jan

2 Mortality Data for UMMS When Shore Health System joined UMMS, there appeared to be an opportunity to improve mortality at Dorchester General Hospital. Mortality by Diagnosis Patients with sepsis have the highest mortality rate. Sepsis accounts for 28% of total mortality despite accounting for only 2% of total admissions. n=89 n=22 n=70 n=50 n=62 2

3 Investigation at SHS An extensive chart review that included 6 months of records for patients with sepsis at Dorchester. Patients were identified with sepsis, but not being treated appropriately. Only 2 of the 12 patients in severe sepsis were admitted to the ICU. Lactate levels were not being drawn (key to prompt identification of severe sepsis). The investigation concluded that the Surviving Sepsis Campaign guidelines were not being followed. Action plan: Implement the campaign guidelines. Sepsis Statistics The leading cause of death in non-coronary intensive care units The 13th cause of death in the US Approx. 750,000 cases of sepsis occur annually Crude mortality rate (all combined from mild to severe) is around 35% Severe sepsis and septic shock carries a mortality rate of % 3

4 SHS Implementation of Surviving Sepsis Campaign SHS created an order set based on the Surviving Sepsis Campaign Guidelines. Tracking of order set use compliance began in Dec 07 and is currently close to 100%. SHS Fluid Resuscitation Monitoring of fluid resuscitation began in July

5 SHS Admission to the ICU Admitting patients to the ICU with severe sepsis was initially identified as a problem at Dorchester. After education and training, the compliance has substantially improved. Improved Mortality for Severe Sepsis At a goal of 35% mortality: 15 Lives saved every year Goal Met! At goal of 30% mortality: 20 Lives saved/year every year How Low Can We Go? 5

6 UMMS Annual Opportunity Analysis UMMS performs an opportunity analysis annually to look for areas of clinical improvement Sepsis identified as a major contributor of mortality within the UMMS acute care hospitals UMMS Response to Sepsis A system task force was formed including physicians and health care providers from all UMMS facilities that reviewed suggested guidelines and order sets Every facility contributed to the final outcome of the task force recommendations and guidelines 6

7 UMMS Sepsis Management Guidelines Developed sepsis management guidelines to be used for all UMMS acute care hospitals 5 key goals of the sepsis guidelines The guidelines include: Evidence based review of literature International guidelines Expert opinion from task force Key Goals of Sepsis Guidelines 1. Early identification of patients with sepsis 2. Adequate fluid administration 3. Early control of the source of infection a. Appropriate broad spectrum antibiotics b. Surgical intervention if indicated 4. Aggressive correction of organ and tissue hypoperfusion 5. Expeditious transfer to the ICU 7

8 System Task Force Representatives Harold Standiford, MD-Chair Infection Control UM Medical Center Baddia Faddoul Clinical Effectiveness UM Medical Center Stuart Jacobs, MD Pulmonary Critical Care Balt-Wash Med Center Steven B. Johnson, MD Surgery/Critical Care UM Medical Center Surjit Julka, MD Pulmonary Critical Care Maryland General Molly Punzo, MD Quality Shore Health System Neal Reynolds, MD Critical Care Kernan Glenn Robbins, MD CMO UM Medical System Raj Shah Infection Control Maryland General Peggy Simon, MD Pulmonary Critical Care University Specialty Christina Stevenson, DPT Quality UM Medical System Ryan Tall-Foster, RN Critical Care Shore Health System Avelino Verceles, MD Pulmonary Critical Care University Specialty Neel Vihibaker, MD Emergency Medicine Balt-Wash Med Center Michael Winters, MD Emergency Medicine UM Medical Center Terrie Young Quality University Specialty QUESTIONS? Thank you 8