Achieving Sepsis Performance Excellence in the Emergency Department

patient with IV in hand

Excellence in the management of severe sepsis and septic shock, and compliance with SEP-1, the national core measure for sepsis, are top priorities for healthcare leaders across the country. This priority is driven by an increasing incidence of sepsis that coincides with disproportionate growth of the elderly population in the U.S., high mortality associated with the condition (up to 50% of patients who die in hospitals are diagnosed with sepsis, approximately 270,000 annually), and its staggering costs (the 2019 cost of sepsis care for inpatient admissions and SNF admissions was well over $50 billion).

Early detection and coordinated treatment can significantly reduce mortality rates for patients presenting to the ED with sepsis. In fact, some studies show that mortality from sepsis increases by as much as 8% for every hour that antibiotic treatment is delayed. Emergency departments that develop a targeted quality initiative around sepsis detection and treatment consistently achieve better outcomes and improved sepsis bundle performance. In this post, former VEP Healthcare Chief Quality Officer Robert Wyman, MD, shares key best practices that drive excellent sepsis performance at our emergency departments.

92% of our partner facilities see significant sepsis performance improvement within one year of implementing our quality program.

Keys to Achieving Sepsis Performance Excellence

Establish a “Code Sepsis” Process to Trigger Coordinated Sepsis Response

Develop a “Code Sepsis” process that is triggered when a patient presents as possibly septic. This ensures a consistent, coordinated, evidence-based approach to get interdisciplinary team members to the bedside, labs ordered, and treatment started in a timely manner that makes sense for patient care.

Collaboratively Review Your Processes

Sepsis is a complicated condition requiring the casting of a wide net to ensure early identification of sepsis patients, followed by treatment with approved antibiotics, frequently large amounts of intravenous fluids, and sometimes vasopressors to maintain acceptable blood pressure. Detailed examination of how quickly and appropriately your emergency department staff carry out these tasks is crucial to improving sepsis treatment processes. We recommend establishing a regular interdisciplinary review of the care of patients admitted for sepsis to identify areas where your program may potentially have issues.

Provide Robust and Regular Provider Education

No amount of process review or discussion is impactful to sepsis outcomes and performance metrics without ample education for those responsible for implementing the process. Ensure provider teams are educated on the importance of sepsis, critical facts associated with sepsis treatment, and impactful documentation of best practices related to sepsis. When providers and nursing staff understand why processes are designed the way they are, they are empowered to execute well and to speak up when they witness issues or have ideas for improvement.

Implement Dedicated “Real-Time” Sepsis Coordinators

At many emergency departments that achieve high levels of sepsis performance, there is a sepsis coordinator who is extremely knowledgeable about sepsis, monitors the care of sepsis patients while they are in the ED, and provides real-time suggestions to the staff to ensure that all of the necessary steps in sepsis care are carried out. A sepsis coordinator often closes the small gap between “good” and “outstanding” sepsis management.

Ensure Engaged Physician and Nursing Sepsis Champions Exist On-Site

Sepsis performance is as strong as the leaders implementing sepsis processes. Sepsis excellence is more likely to be achieved when there are physician and nurse “sepsis champions” who are passionate and diligent about evaluating sepsis care and providing feedback and education to the staff to improve performance.

Focus on Sepsis Order Sets and Required Documentation  

A crucial element of sepsis education and case review is charting of all the required elements of sepsis evaluation and care.  Achieving sepsis performance excellence requires dialing in what to order and how to chart it, and equipping providers with knowledge to execute best practices. Ensure that your teams know what Centers for Medicare and Medicaid Services (CMS) is looking for in documentation and develop a flexible sepsis order set that permits providers to efficiently order all that is needed.

Bottom Line: Collaborative Process Development, Review, and Education Drives Sepsis Success

Sepsis is one of the most important conditions emergency departments handle. When it is not managed correctly, it is life-threatening for patients and costly for both hospitals and patients. Optimizing treatment and documentation of sepsis cases helps to reduce mortality rates, readmissions, length of stay, and cost of care. Establishing a “CodeSepsis,” developing a sepsis order set, educating providers on treatment and documentation best practices, comprehensive sepsis case review with feedback to the staff, and on-site sepsis champions are hallmarks of our quality program that consistently drive excellent sepsis performance.