| Description |
Background: Sepsis is a complex disease process with significant mortality and cost of care. Sepsis accounts for approximately 10% of all United States hospitalizations and nearly one in three in-hospital deaths. The purpose of this project was to evaluate how sepsis is identified and treated in a local emergency department (ED) by assessing how providers order diagnostic and interventional care within the electronic medical record (EMR) including the use of an electronic ordering set (Power Plan). Methods: Thirty-eight emergency medicine providers were asked to evaluate their standard approach to sepsis care. Providers participated in a pre-survey, a presentation and discussion focusing on standard sepsis treatment processes and ideal ordering behaviors, and a follow-up post-survey. Retrospective inpatient data from January-June 2019 was compiled for patients with an admitting diagnosis of sepsis, septicemia, bacteremia or septic shock and analyzed to create an objective description of sepsis care, admission, and sepsis outcomes at the study site.Results: Sepsis care within the study facility was excellent with an overall mortality rate of 6.07% compared to national averages of 12.5%-15%. After receiving treatment, 82.63% of patients were discharged with a relative expected mortality risk below their risk of mortality on admission. Advancing age demonstrated the largest risk for mortality risk on admission (F3, 589=61.76, p=0.00); however, underlying pre-existing individual factors (e.g. tobacco use, obesity) were more predictive of mortality risk after inpatient treatment (X2 3, 589=26.76, p=0.00). Provider compliance to three-hour bundle treatment algorithms was variable with room for improvement in antibiotic compliance (29.73% outside of the algorithm standard of 3 hours).Survey results showed very few (19%) providers utilized the full workup option within the Power Plan but instead reported frequent use (71%) of the individualized ordering menu within the EMR, tailoring care based on individual patient presentation. Thirty-three percent of providers reported they never use the EMR order set for diagnostic ordering and less than half of providers reported that the sepsis Power Plan Guidelines were useful in clinical practice.Discussion: On admission, advancing age, sepsis stemming from a gastrointestinal source, and patients with pre-existing conditions such as an elevated BMI and tobacco use should receive special attention as these populations are at increased risk of mortality. After treatment, the greatest predictor of patient mortality was pre-existing chronic health conditions indicating that sepsis is treated appropriately in this ED and that individual health factors continue to threaten the health and well-being of patients. Timely and appropriate antibiotic administration in sepsis should also be a focus for clinical improvement and should receive priority moving forward. Conclusion: Management of sepsis is complex and continues to create challenges for providers. Identification and treatment of high-risk mortality groups is paramount to minimize patient mortality. Although Power Plans may not meet every provider's ordering preference, revisions to these plans with appropriate provider input could optimize content and streamline use, which may result in more provider buy-in and could improve antibiotic administration schedules, better meet sepsis care metrics, and improve patient outcomes. |
