Multimodal Quality Initiatives In Sepsis: Impact On Core Measures And Outcomes

ABSTRACT

RATIONALE The Center for Medicare and Medicaid requires hospitals to report compliance with a sepsis treatment bundle as part of its Inpatient Quality Reporting Program. Cleveland Clinic Foundation (CCF) Fairview hospital reported a Sepsis Core Measure Compliance (SEP-1) of 25% and a mortality averaging 20% in 2017. Both were very dismaying. METHODS: Starting in 2018 a sepsis committee was convened with a plan for several quality initiatives. Real-time audits and peer to peer education were provided to caregivers on the failed cases. A sepsis alert in the Electronic medical record system and a sepsis checklist were initiated. In 2020 a Code sepsis team was created with 24 hours response and follow-up on all sepsis alerts. As the CCF enterprise decided in 2020 to focus on mortality reviews, our hospital adopted rather a hybrid model reviewing all failed compliance cases of the one hour antibiotic in addition to mortality cases reviews. Several educational and awareness sessions were entertained with the residents, advanced practice providers, hospitalists, intensivists and nursing teams. Seventy Registered Nurses received training in 2018 and forty-three in 2021. Sepsis Champions were designated encompassing all stakeholders. Collaboration with Emergency Room caregivers to provide hand-off communication on sepsis alert patients to the medical-surgical providers ensured continuity of care. A sepsis order set was revised and went live in September 2021. Beginning of 2022, A dedicated full time quality coordinator and program manager for sepsis was appointed. RESULTS: Despite the Coronavirus 19 infection (COVID 19) pandemic where Cleveland Clinic Fairview Hospital was designated as the tertiary referral academic center for northwestern Ohio and despite the inclusion of COVID 19 mortality within the sepsis mortality data, comparing 2017 to 2021, SEP-1 measures compliance improved from 25% to 60.4% and sepsis mortality decreased from 20% to 15.38%. The one hour antibiotic compliance averaged 78.89% in 2021. With the above performance and impact on survival, Cleveland Clinic Fairview Hospital was leading the CCF Hospitals both in compliance and Mortality. Several of the above Fairview hospital quality initiatives and approaches were later adopted across the Cleveland Clinic Hospitals. CONCLUSION: A sepsis dedicated committee, quality/program manager and a code sepsis team with a focus on the evidence base components of the sepsis core measures, all helped improve compliance and decrease mortality. Future research is needed to highlight the impact of each of those quality and educational initiatives on outcomes and performance. Word Count 400 (Figure Presented).