San Mateo Medical Center

Simple Changes Cut Sepsis Mortality Rate

Each year, hospitals nationwide will treat about one million cases of sepsis. Thirty percent of patients will die within 30 days and 20 percent more will die within five months of admission of sepsis. It has a mortality rate equal to that of lung disease and breast cancer combined and is the most common cause of preventable death in hospitals.
 
To decrease mortality rates of sepsis within California’s Bay Area, San Mateo Medical Center (SMMC) collaborated with eight other area hospitals in the University of California, San Francisco Integrated Nurse Leadership Program Sepsis Mortality Rate Reduction Project from October 2009 to April 2011. At SMMC, death rates from sepsis dropped by almost half from nearly 40 percent to about 21 percent during the project.

“It’s a wonderful accomplishment to celebrate and a testament to what you can do when staff at all types and all levels focus on a single goal,” said Susan Ehrlich, MD, SMMC’s chief executive officer.

The project included staff from medical records, the quality department, pharmacy and laboratory, as well as bedside caregivers including nurses and physicians. It was implemented in the emergency department, intensive care unit and the medical-surgical department.
 
To improve patient outcomes, the program involved enforcing guidelines for consistent use of the sepsis screening tool, while implementing a “sepsis bundle” (lactate, blood culture, antibiotic and fluid resuscitation) as a means for delivering early goal-directed therapy. Sepsis screening and treatment was added to SMMC’s electronic medical records and nurses were charged with driving orders for screenings.

“When we don’t have standards, treatment is driven by patient experience and preference,” Ehrlich said. “An evidence-based practice has to be carried out in a standardized fashion to be effective.”

Through the project, the hospital exceeded its median target 95 percent compliance rate with sepsis screening, while compliance rates for early goal-directed therapy increased from 52 percent to 83 percent.

In addition to standardizing sepsis screening and treatment processes, staff education was an integral part of the hospital’s outcomes. Staff was trained to perform ongoing “Tests of Change” using the “Plan Do Study Act Model,” developed by Associates in Process Improvement. The sepsis team conducted regular chart and case reviews, reporting results to multiple committees including one on quality improvement.

The SMMC sepsis team discussed Tests of Change and case reviews, identifying processes for further improvement during both an internal bi-weekly meeting and collaborative quarterly meeting.
 
“That’s the beauty of a collaborative,” Ehrlich said. “We share with one another successes, failures and creative work. It helps everyone in succeeding.”
Although the collaborative project has concluded, SMMC is working to deepen and maintain the reduction of hospital sepsis mortality rates. To prepare for health care reform in 2014, California public hospitals will have to report data on sepsis treatment to the state and federal government across the next four years.
“Sepsis screening and treatment is not just going to be important to our hospitals,” Ehrlich said. “It’s going to be imperative.”

Related Article:
Colliver, Victoria. “Sepsis: Bay Area Hospitals Sharply Cut Death Rates.” San Francisco Chronicle. April 21, 2011.