I've set up a couple of spreadsheets to look at the timing of the bundle measures more closely. Even though we're on Epic, have MIDAS and eICU data, it's difficult to get case level data to analyze. We review every septic shock case and the data has helped support the case for EGDT. We found that the mortality rate doubled for patients who developed septic shock if they did not receive an adequate fluid bolus at the onset of severe sepsis (mortality rate of 17% for adequate fluid resuscitation vs. 38% for patients who did not receive adequate fluid resuscitation). It's espcially compelling when clinicians see the graph over the last year that shows that patient mortality goes down when compliance with the initial fuid bolus goes up. The database also allowed us to drill down on potential systems barriers to implementing the bundle ( ie- looking at the time between antibiotic order and start time of the antibiotic, or time of lactate draw to result).
When we looked at mortality rate for the range of first lactate values, we found that there was a 20% mortality rate for patients with lactates between 1.5 and 1.9. I aldo set up a workbench report in Epic to give me all lactates >= 2.0 each morning, then track the care of the patient. In 80% of the cases, a patient with an initial lactate of >= 2.0 develops sepsis, severe sepsis or septic shock based on the SSC criteria. An interesting finding was that 35% of those patients had a normal WBC (>4 WBC <12). It's labor intensive to do the chart reviews and reports, but the data has been very helpful in supporting our sepsis mortality reduction campaign. Regards, Chuck Charles Pitkofsky, RN, MSN Quality Manager Department of Quality Management Mills-Peninsula Health Services 1501 Trousdale Drive Burlingame, CA 94010-4506 Phone 650-696-7880 Confidentiality Notice: This transmission and any attached documents may be confidential and contain information protected by State and Federal Medical Privacy statutes and is legally privileged. They are intended for use only by the addressee. If you are not the intended recipient of this transmission, or an agent of the intended recipient, you are prohibited from reading, disclosing, printing, saving, copying or using or otherwise disseminating any information contained in this transmission. If you received this transmission in error, please accept my apology and notify the sender via reply email. Please delete the entire message and its attachments. Thank you _____________________________________________________________________________________________ Message: 1 Date: Wed, 17 Apr 2013 16:21:38 -0400 From: "Hussey, Joann" <[email protected]> To: <[email protected]> Subject: [Sepsis Groups] Data Collection Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" Hi All, We are currently collecting sepsis bundle data for ED patients and reviewing for appropriateness of care. Our organization is in the process of conducting an environmental scan with the goal of improving our processes. I'm reaching out to see if anyone is reviewing any additional sepsis measures, either ED or in-house. Any data collection forms or info you can share, is appreciated. Thanks, JoAnn Hussey, RN, BSN Performance Improvement Coordinator Robert Wood Johnson University Hospital 732-828-3000 ext. 8210 [email protected] _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
