Severe Sepsis And HAI Mortality SEVERE SEPSIS 2004: 14000 DEATHS 300 per million dying of severe sepsis in any one year ODDS: 1 in 3333 SEPSIS in UK: 37000 DEATHS ODDS 1 in 125 MRSA & CDI 2006: 8132 DEATHS 91 per million dying of MRSA or CDI in any one year. ODDS: 1 in 11,000. –For those aged under 45 years : 1 in 250,000. –For those aged 85 years or older, 1 in 300. www.statistics.gov.ukwww.statistics.gov.uk); ; UK Sepsis Group Harrison D et al Critical Care 2006; 10:R42
Copyright 2010 by the American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use. American Medical Association, 515 N. State St, Chicago, IL 60610. Published by American Medical Association. 2 Sepsis in General Surgery: The 2005-2007 National Surgical Quality Improvement Program Perspective. Moore, Laura; Moore, Frederick; Todd, S; Jones, Stephen; Turner, Krista; Bass, Barbara Archives of Surgery. 145(7):695-700, July 2010. Surgical Sepsis
15,022 Patients 165 Hospitals Median of 14 Months Mortality Decreased from 37 to 30.8 Percent 6.2% Absolute 16% Relative
STAG Sepsis Management in Scotland Signs of sepsis < 2 days 2% of emergency admissions (~5000) 71% had a EWS 34% had severe sepsis 21% blood cultures 32% IV Antibiotics 70% IV fluids Scottish Defect Rate was 18-74%
Why is implementation so difficult? Too many elements in the bundle Some are controversial Time Sensitive Process Difficult To Diagnosis Sepsis Early Human Factors Get In The Way Invasive procedures needed ICU stuff??
Reliable Sepsis screening (EWS + SIRS) Ensure reliable communication across clinical teams of at risk patients Ensure timely rescue of deteriorating patient by competent teams To improve the recognition and timely management of Sepsis in acute hospitals Outcome: Reduction in mortality in pilot population from Sepsis 5% by December 2012 10% by December 2014 AIM Reliable Recognition & Assessment Reliable Care Delivery Education & Awareness Culture of safety and Quality Improvement PRIMARY DRIVERS Ensure reliable delivery of Sepsis Six within 1 hour Source Control Ensure reliable escalation of septic patients to higher level of care Improve Antimicrobial stewardship - 3 day review Education on burden of illness & current performance Provide training to staff on clinical knowledge and improvement skills Executive Sponsorship Clinical Leadership Multidisciplinary team working Develop measurement frameworks to guide improvement Involve patients & families in treatment process and care planning SECONDARY DRIVERS Patient & Family Centred Care JOINT COLLABORATIVE - SEPSIS DRIVER DIAGRAM
Spreading Ink blot Strategy Based on military tactics –Small area of “Good Practice” across site –As expand will join up MAU ED Surgical –Hospital At night –Medical Wards –DOME Acute Medical Unit Acute Surgical RAH ED