Effective Identification of Sepsis in the Emergency Department

Background: Severe sepsis is the leading cause of death at the University of Utah Hospital (UUH). In the University of Utah's emergency department (ED), sepsis capture and treatment remained at only 25%. We created an educational module and a sepsis checklist tool for the ED nursing staff which resulted in an increase to 45% capture of septic patients admitted to the hospital from the ED. Purpose: The purpose of this project was to evaluate the effectiveness of the sepsis education offered, determine how the sepsis checklist tool (SCT) is used, and assess the barriers preventing the complete capture of septic patients who were admitted to the UUH through the ED. Methods: Nursing staff surveys were issued to all registered nurses (RN) working at the UUH ED, followed by a patient chart audit of the sepsis capture tool performed pre-intervention (n=1220) and post-implementation (n=1002). Results: Of the 122 RN participants, 85 (70%) completed the nursing surveys. Significant differences existed between the pre and post-SCT groups achieving 180-minute bundle goals: time to lactate (p=0.003) and time to blood cultures (p=<0.0001) after a Modified Early Warning Score (MEWS) >5. No significant differences existed among time to antibiotic (p=0.707), time to intravenous fluids (p=0.728), and length of stay (LOS) (p=0.736) or mortality (p=0.595). Conclusions: The majority of RN's predominately stated that the mandatory sepsis education module was helpful and that the SCT was user friendly and feasible for their practice. Barriers to early sepsis capture and treatment in the ED include high staff turnover, challenges with identifying septic patients, SCT format flaws (e.g., paper vs electronic), information saturation with multiple learning initiatives, and provider discretion incongruities. Addressing these barriers has the potential to positively affect septic patient outcomes.