Institutional Structures and Processes to Support Sepsis Care: A Multihospital Study
OBJECTIVES:. To identify opportunities for improving hospital-based sepsis care and to inform an ongoing statewide quality improvement initiative in Michigan. DESIGN:. Surveys on hospital sepsis processes, including a self-assessment of practices using a 3-point Likert scale, were administered to 51...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2023-11-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000001004 |
| _version_ | 1797449581066190848 |
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| author | Meghan K. Lóser, MD Jennifer K. Horowitz, MA Peter England, MD Rania Esteitie, MD Scott Kaatz, DO, MSc, FACP, SFHM Elizabeth McLaughlin, MS, RN Elizabeth Munroe, MD Megan Heath, PhD Pat Posa, RN, BSN, MSA, CCRN-K, FAAN Scott A. Flanders, MD Hallie C. Prescott, MD, MSc |
| author_facet | Meghan K. Lóser, MD Jennifer K. Horowitz, MA Peter England, MD Rania Esteitie, MD Scott Kaatz, DO, MSc, FACP, SFHM Elizabeth McLaughlin, MS, RN Elizabeth Munroe, MD Megan Heath, PhD Pat Posa, RN, BSN, MSA, CCRN-K, FAAN Scott A. Flanders, MD Hallie C. Prescott, MD, MSc |
| author_sort | Meghan K. Lóser, MD |
| collection | DOAJ |
| description | OBJECTIVES:. To identify opportunities for improving hospital-based sepsis care and to inform an ongoing statewide quality improvement initiative in Michigan.
DESIGN:. Surveys on hospital sepsis processes, including a self-assessment of practices using a 3-point Likert scale, were administered to 51 hospitals participating in the Michigan Hospital Medicine Safety Consortium, a Collaborative Quality Initiative sponsored by Blue Cross Blue Shield of Michigan, at two time points (2020, 2022). Forty-eight hospitals also submitted sepsis protocols for structured review.
SETTING:. Multicenter quality improvement consortium.
SUBJECTS:. Fifty-one hospitals in Michigan.
INTERVENTIONS:. None.
MEASUREMENTS AND MAIN RESULTS:. Of the included hospitals, 92.2% (n = 47/51) were nonprofit, 88.2% (n = 45/51) urban, 11.8% (n = 6/51) rural, and 80.4% (n = 41/51) teaching hospitals. One hundred percent (n = 51/51) responded to the survey, and 94.1% (n = 48/51) provided a sepsis policy/protocol. All surveyed hospitals used at least one quality improvement approach, including audit/feedback (98.0%, n = 50/51) and/or clinician education (68.6%, n = 35/51). Protocols included the Sepsis-1 (18.8%, n = 9/48) or Sepsis-2 (31.3%, n = 15/48) definitions; none (n = 0/48) used Sepsis-3. All hospitals (n = 51/51) used at least one process to facilitate rapid sepsis treatment, including order sets (96.1%, n = 49/51) and/or stocking of commonly used antibiotics in at least one clinical setting (92.2%, n = 47/51). Treatment protocols included guidance on antimicrobial therapy (68.8%, n = 33/48), fluid resuscitation (70.8%, n = 34/48), and vasopressor administration (62.5%, n = 30/48). On self-assessment, hospitals reported the lowest scores for peridischarge practices, including screening for cognitive impairment (2.0%, n = 1/51 responded “we are good at this”) and providing anticipatory guidance (3.9%, n = 2/51). There were no meaningful associations of the Centers for Medicare and Medicaid Services’ Severe Sepsis and Septic Shock: Management Bundle performance with differences in hospital characteristics or sepsis policy document characteristics.
CONCLUSIONS:. Most hospitals used audit/feedback, order sets, and clinician education to facilitate sepsis care. Hospitals did not consistently incorporate organ dysfunction criteria into sepsis definitions. Existing processes focused on early recognition and treatment rather than recovery-based practices. |
| first_indexed | 2024-03-09T14:27:06Z |
| format | Article |
| id | doaj.art-aa31b20809de4786a76d1ab8b8f0ccb6 |
| institution | Directory Open Access Journal |
| issn | 2639-8028 |
| language | English |
| last_indexed | 2024-03-09T14:27:06Z |
| publishDate | 2023-11-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj.art-aa31b20809de4786a76d1ab8b8f0ccb62023-11-28T07:08:04ZengWolters KluwerCritical Care Explorations2639-80282023-11-01511e100410.1097/CCE.0000000000001004202311000-00012Institutional Structures and Processes to Support Sepsis Care: A Multihospital StudyMeghan K. Lóser, MD0Jennifer K. Horowitz, MA1Peter England, MD2Rania Esteitie, MD3Scott Kaatz, DO, MSc, FACP, SFHM4Elizabeth McLaughlin, MS, RN5Elizabeth Munroe, MD6Megan Heath, PhD7Pat Posa, RN, BSN, MSA, CCRN-K, FAAN8Scott A. Flanders, MD9Hallie C. Prescott, MD, MSc101 Department of Internal Medicine, University of Michigan, Ann Arbor, MI.1 Department of Internal Medicine, University of Michigan, Ann Arbor, MI.2 Department of Emergency Medicine, University of Michigan, Ann Arbor, MI.3 Division of Pulmonary & Critical Care Medicine, Covenant Healthcare, Saginaw, MI.4 Division of Hospital Medicine, Henry Ford Hospital, Detroit, MI.1 Department of Internal Medicine, University of Michigan, Ann Arbor, MI.5 Division of Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, MI.1 Department of Internal Medicine, University of Michigan, Ann Arbor, MI.6 Quality and Patient Safety Program, University of Michigan, Ann Arbor, MI.1 Department of Internal Medicine, University of Michigan, Ann Arbor, MI.5 Division of Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, MI.OBJECTIVES:. To identify opportunities for improving hospital-based sepsis care and to inform an ongoing statewide quality improvement initiative in Michigan. DESIGN:. Surveys on hospital sepsis processes, including a self-assessment of practices using a 3-point Likert scale, were administered to 51 hospitals participating in the Michigan Hospital Medicine Safety Consortium, a Collaborative Quality Initiative sponsored by Blue Cross Blue Shield of Michigan, at two time points (2020, 2022). Forty-eight hospitals also submitted sepsis protocols for structured review. SETTING:. Multicenter quality improvement consortium. SUBJECTS:. Fifty-one hospitals in Michigan. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Of the included hospitals, 92.2% (n = 47/51) were nonprofit, 88.2% (n = 45/51) urban, 11.8% (n = 6/51) rural, and 80.4% (n = 41/51) teaching hospitals. One hundred percent (n = 51/51) responded to the survey, and 94.1% (n = 48/51) provided a sepsis policy/protocol. All surveyed hospitals used at least one quality improvement approach, including audit/feedback (98.0%, n = 50/51) and/or clinician education (68.6%, n = 35/51). Protocols included the Sepsis-1 (18.8%, n = 9/48) or Sepsis-2 (31.3%, n = 15/48) definitions; none (n = 0/48) used Sepsis-3. All hospitals (n = 51/51) used at least one process to facilitate rapid sepsis treatment, including order sets (96.1%, n = 49/51) and/or stocking of commonly used antibiotics in at least one clinical setting (92.2%, n = 47/51). Treatment protocols included guidance on antimicrobial therapy (68.8%, n = 33/48), fluid resuscitation (70.8%, n = 34/48), and vasopressor administration (62.5%, n = 30/48). On self-assessment, hospitals reported the lowest scores for peridischarge practices, including screening for cognitive impairment (2.0%, n = 1/51 responded “we are good at this”) and providing anticipatory guidance (3.9%, n = 2/51). There were no meaningful associations of the Centers for Medicare and Medicaid Services’ Severe Sepsis and Septic Shock: Management Bundle performance with differences in hospital characteristics or sepsis policy document characteristics. CONCLUSIONS:. Most hospitals used audit/feedback, order sets, and clinician education to facilitate sepsis care. Hospitals did not consistently incorporate organ dysfunction criteria into sepsis definitions. Existing processes focused on early recognition and treatment rather than recovery-based practices.http://journals.lww.com/10.1097/CCE.0000000000001004 |
| spellingShingle | Meghan K. Lóser, MD Jennifer K. Horowitz, MA Peter England, MD Rania Esteitie, MD Scott Kaatz, DO, MSc, FACP, SFHM Elizabeth McLaughlin, MS, RN Elizabeth Munroe, MD Megan Heath, PhD Pat Posa, RN, BSN, MSA, CCRN-K, FAAN Scott A. Flanders, MD Hallie C. Prescott, MD, MSc Institutional Structures and Processes to Support Sepsis Care: A Multihospital Study Critical Care Explorations |
| title | Institutional Structures and Processes to Support Sepsis Care: A Multihospital Study |
| title_full | Institutional Structures and Processes to Support Sepsis Care: A Multihospital Study |
| title_fullStr | Institutional Structures and Processes to Support Sepsis Care: A Multihospital Study |
| title_full_unstemmed | Institutional Structures and Processes to Support Sepsis Care: A Multihospital Study |
| title_short | Institutional Structures and Processes to Support Sepsis Care: A Multihospital Study |
| title_sort | institutional structures and processes to support sepsis care a multihospital study |
| url | http://journals.lww.com/10.1097/CCE.0000000000001004 |
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