Quality Improvement Project for Early Sepsis Iintervention and Education with Pre-Hospital EMS Teams

In the United States, sepsis is currently the third leading cause of death, and the number one leading cause of death of hospitalized patients (CDC, 2018; HCUP, 2016). Each year the United States pays over 27.4 billion dollars in the management and treatment of hospitalized patients with sepsis (HCUP, 2016; CDC, 2016). Current research is finding that about 50% of all patients diagnosed with sepsis in the Emergency Department (ED) are brought in via ambulance by Emergency Medical Service (EMS) teams. Multiple studies have shown a lack of early recognition by EMS personnel, which leads to poorer patient outcomes (Grover, Vacarelli, Williams, & Cabanas, 2016). The purpose of this paper was to explore the implementation of a quality improvement project focused sepsis education for pre-hospital emergency medical staff (EMS) personnel. The foci of the project were to (a) evaluate the impact of earlier recognition and treatment initiation of septic patients by EMS personnel prior to transport to the Emergency Department (ED), (b) increase confidence of EMS personnel on their ability to recognize signs and symptoms of sepsis earlier, and (c) monitor the number of sepsis bundle checklists implemented by EMS personnel. Other important factors that were monitored and compared with this quality improvement project include patient outcomes and length of hospital stay. This quality improvement project initiative included education, with a pre and post survey analysis by EMS personnel. The EMS personnel included in the project were all paramedics (PMs) and emergency medical technicians (EMTs) from a local Fire Department within the Salt Lake City region (N= 254). Analysis of the pre-, post-, and follow-up surveys using a Wilcoxon signed-rank test found a statistically significant change in early recognition and interventions of sepsis care (Z= -2.335, p= 0.020). Pre-survey results found 65.7% of EMS personnel stated they felt early sepsis identification and treatment was crucial to patient survival rates and outcomes. Post education, via the post-survey, 87.7% stated they felt early sepsis identification and treatment was crucial to patient survival rates and outcomes. This was a 22% increase in EMS personnel understanding. These results indicate the educational presentation was effective in helping pre-hospital personal better understand the early signs and symptoms of sepsis and appropriate interventions prior to ED arrival. This type of project is feasible to implement and received great satisfaction from EMS personnel. Having a sepsis checklist that listed appropriate early sepsis interventions increased EMS confidence in the identification and care of patients at risk, in the early stages of sepsis, or in the stages of septic shock.