Conquering Sepsis Mortality: Teamwork Makes the Dream Work ` Christa A. Schorr RN, MSN, FCCM Assistant Professor of Medicine Cooper Medical School of Rowan University Director of Databases for Quality Improvement and Research Program Director of Critical Care Clinical Trials Cooper University Hospital

The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis SSC North American Summits Underway 2007 Sepsis 2012: What's Hot and What's Not Sponsored by: New Jersey Hospital Association

Establish teams locally

AlignmentIdentificationCollaborationHigh performance 4 Phases of Teamwork =

Aligning the team Clarify values, purpose and vision Set realistic, quantifiable objectives Clarify roles and responsibilities Organize for effectiveness Establish team guidelines

6 Establish an Aim Statement Example: By March 2013 Our team intends to improve time to antibiotics for ED admissions to 3 hours Improvement will be measured by a 25% increase in antibiotic indicator compliance –(60% currently - goal 75%)

7 Multidisciplinary cross-departmental alignment

Will the teams be receptive?

Patrick Lencioni 2002

leadership enthusiasmenthusiasm No Egos Conflict resolution competence TrustTrust Develop Transform Lead Follow camaraderie

Identification phase Refine roles and responsibilities Manage conflict, clarify expectations and re-establish accountability Promote and set team identity

Recruiting the team Received 2008 AACN Excellence in Collaboration Award Multidisciplinary

Teamwork behaviors Leadership Situational awareness Workload management Resource management Briefings Debriefings Sehgal N et al J Gen Intern Med 2008 December; 23(12):

Manojlovich M and DeCicco, B. Am J Crit Care 2007

Value of nurses at the bedside Empower nurses to recognize and report severe sepsis

Collaboration phase Learn how each team performs best Develop feedback paths Promote increasing autonomy for higher performance

18 ICU ED Role of Collaboration

19 Effective interventions for change Active involvement Audit and feedback Local consensus process Reminders-prompts Interactive educational material Interventions targeting barriers Gross P Jt Comm on Qual Improvement. 26(9)

Feedback Data - Data and more data

Facilitate guideline recommendations January 2005-March ,022 subjects at 165 sites Result: –sustained continuous quality improvement Critical Care Medicine. 38(2): , February 2010

Protocols: Implementation Consistently Reduces Mortality Sebat F, et al. Chest. 2005;127: ; Kortgen A, et al. Crit Care Med. 2006;34(4): ; Shapiro NI, et al. Crit Care Med. 2006;34(4): ; Micek ST, et al. Crit Care Med. 2006;34(11): *P <.05 compared with control; In-hospital mortality; 28-day mortality. * * *

Schramm GE Crit Care Med 2011 Vol. 39, No. 2

High performance phase Anticipate each others behavior and operate with extreme efficiency Encourage innovative thinking Solve problems quickly Practice team renewal

Celebrate -team renewal

DreamTeam + Plan = Success

Thank you