Stony Brook University Medical Center

Reducing Sepsis Mortality with the Use of ‘Sepsis Bundles’

Sepsis is a major contributor to mortality in hospitals across the United States killing nearly 1,400 people each day. Given the extremely high mortality rates associated with severe sepsis (30 to 50 percent) and septic shock (50 to 60 percent) and the particular risk sepsis poses for critically ill patients, staff at Stony Brook University Medical Center (SBUMC) decided to take action. In 2006, SBUMC joined the international Surviving Sepsis Campaign and adopted the campaign’s goal of reducing sepsis mortality by 25 percent in the hospital from a baseline mortality rate of 26.7 percent (from January to December 2006) to 20.03 percent.

To accomplish the goal of reducing sepsis mortality, SBUMC implemented a modified version of the campaign’s sepsis resuscitation bundle. The modified sepsis resuscitation bundle is not only administered within the first 6 hours after presentation, but also requires blood culture collection prior to antibiotics, serum lactate measurements, antibiotic timing and selection, and fluids and vasopressors for hypotension. SBUMC implemented the bundle throughout the hospital, including in the surgical and medical intensive care units (ICUs) and the emergency department (ED). The bundle was also adapted for use in the pediatric ICU and pediatric urgent care.

Sepsis screening tools were used to screen in the critical care units at admission, daily and as needed, and in triage to screen patients upon presentation in the ED. Patients presenting to the ED with high fevers (greater than 100.9 degrees Fahrenheit) were flagged in the triage system to receive a fever panel and sepsis rule-out panel. A copy of the severe sepsis screening tool was copied onto the back of the rapid response team form to ensure each response team conducted a sepsis screening on each call. SBUMC also implemented a policy requiring an automatic call from the lab to the unit/department for any patient with a lactate critical value (greater than or equal to 4 mmol/L). Additionally, an automatic reorder of serum lactate is placed within 2 hours after a patient’s lab results are returned showing an elevated lactate result of greater than or equal to 2.1 mmol/L, allowing staff to better monitor the treatment’s efficacy.

SBUMC’s campaign to reduce sepsis mortality was extremely successful, resulting in a 49 percent reduction in mortality rate (26.7 percent at baseline vs. 13.6 percent post implementation). The intervention also resulted in a decrease in length of stay for patients with severe sepsis (12.42 days baseline vs. 9.81 days post implementation). Based on an average daily cost of an SBUMC bed of $1,854.39, the decrease in length of stay also means a cost savings of more than $740,000 for the 153 severe sepsis patients at SBUMC in 2010.

SBUMC is the recipient of a 2011 NAPH Safety Net Patient Safety Award for their incredible work in reducing sepsis mortality using modified sepsis bundles.

To learn more about this innovation, please contact:
Christine McMullan
Director of Continuous Quality Improvement
Stony Brook University Medical Center
(631) 444-4709
[email protected]  

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