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J Hosp Med. 2016 Nov;11 Suppl 1:S32-S39. doi: 10.1002/jhm.2656.

Implementation of a multicenter performance improvement program for early detection and treatment of severe sepsis in general medical-surgical wards.

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Cooper Research Institute-Critical Care, Cooper University Hospital, Camden, New Jersey.
Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri.
Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, New York.
Systems Research Initiative, Kaiser Permanente Division of Research, Kaiser Permanente, Oakland, California.
Division of Hospital Medicine, Medical Informatics and Care Delivery Innovation, Cooper University Hospital, Camden, New Jersey.
Department of Quality and Safety, California Pacific Medical Center, San Francisco, California.
Department of Pulmonary, Critical Care, and Sleep Medicine, Rhode Island Hospital, Providence, Rhode Island.


Sepsis is a leading cause of in-hospital death, and evidence suggests a higher mortality in patients presenting with sepsis on the ward compared to those presenting to the emergency department. Ward patients who develop severe sepsis may have poor outcomes for a variety of reasons, including delayed diagnosis, lack of readily available staffing, and delayed treatment. We report on a multihospital quality improvement program for early detection and treatment of sepsis on general medical-surgical wards. We describe a multipronged approach to improve severe sepsis outcomes using the Institute for Healthcare Improvement's Plan-Do-Study-Act model. Sixty sites engaged in a collaborative implementation process that aligned people, process, and technology. Based on our experience, we recommend a stepwise approach to implement such a program: (1) both administrative and clinical leadership commit to a common goal; (2) appoint clinical champions and give them authority to engage other clinicians to improve timeliness of interventions; (3) map workflows and processes to rely heavily on the nursing staff's ability to evaluate and report severe sepsis screening results; (4) if available, design and deploy technology with the assistance of clinical informaticians (eg, to enable electronic health records-based continuous screening); (5) to determine success, consider tracking screening compliance and process, and outcome measures such as length of stay and mortality. Journal of Hospital Medicine 2016;S11:32-S39.

[Indexed for MEDLINE]

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