A quality initiative to improve sepsis bundle compliance through utilization of an ehr tool

ABSTRACT

INTRODUCTION: Sepsis affects nearly 2 million adults each year in the United States. While still a leading cause of mortality, sepsis care has improved with increased awareness, recognition and treatment promoted by the Surviving Sepsis Campaign (SSC). Multiple studies have shown that lower mortality is correlated with increased bundle compliance. Yet, overall compliance remains low reported as 21.5% in one study over 7.5 years and reported as 45% in NY State in 2019. Sepsis care in our institution has been an ongoing focus resulting in achievement of 77% bundle compliance in 2019. In the aftermath of COVID-19, we have renewed our focus on enhancing sepsis care in our emergency department (ED). A multidisciplinary quality improvement (QI) team aimed to optimize a tool, launched September 2019 in our high-volume ED, within our EHR to guide and improve sepsis bundled care compliance. METHODS: A retrospective cohort study to assess sepsis bundle compliance was completed. Adherence to each component (1st and 2nd lactate, timely appropriate antibiotics, blood cultures before antibiotics, fluid resuscitation, hemodynamic reassessment and vasopressor initiation) was compared with and without the use of the EHR tool using descriptive statistics. Simultaneously, an ongoing prospective evaluation of the rate of utilization of the EHR tool was monitored over 3 months. Through QI initiatives, the aim was to increase utilization to > 50% of sepsis cases in the ED. RESULTS: A total of 114 cases were identified. 36% used the EHR tool which led to a higher overall bundle compliance (56% versus 19%), as well as for each individual component. The largest differences were noted in fluid resuscitation (73.2% vs 29.6%), hemodynamic reassessment (61.0% vs 26.8%), and 2nd lactate (96.9% vs. 64.5%). After QI initiatives, including multi-disciplinary education and individualized case feedback, the usage of the EHR tool increased from an average of 23.2% to 76.7%. CONCLUSIONS: An EHR tool, when introduced with education and work flow integration, can assist with bundled care compliance to improve sepsis care. Next steps include obtaining qualitative feedback on the EHR tool's effectiveness and usability to further enhance utilization.