QUALITY IMPROVEMENT ON INPATIENT SEPSIS 1 Sepsis is a complication of an infection that can be life-threatening (Mayo Clinic, 2016).
Sepsis involves the body’s response to an infection. Severe sepsis causes acute organ
dysfunction. Septic shock is hypotension combined with severe sepsis. Sepsis is diagnosed when
a patient has fever, a decreased level of consciousness, hypothermia and elevated inflammatory
markers (Andriolo, Atallah, & Salomão, 2013). Chances of survival improve with early treatment
of sepsis with intravenous fluids and antibiotics (Mayo Clinic, 2016). Mortality rates have been
as high as 50% in patients with sepsis (Andriolo et al., 2013). Intravenous fluids and broad
spectrum antimicrobial therapy are common treatments for sepsis. The purpose of broad
spectrum antimicrobial treatment is to reduce mortality from sepsis. To address sepsis and septic
shock, education should be provided especially to the front line: emergency room physicians, the
nurses, and the community so that sepsis can be identified earlier.
Sepsis and severe sepsis are a financial burden to health care. The total hospital cost for
patients with severe sepsis increased from $15.4 billion in 2003 to $24.3 billion in 2007. (Critical
Care Med. 2012 Oct;40(10):2932). In 2012 the cost of sepsis care in the United States was
estimated to be at $400 billion. (Reducing sepsis mortality. Medsurg Nurs 2014Jan-Feb;23(1):914). When we think of a patient with severe sepsis we primarily assume they will be in the
intensive care unit. The majority of patients (50-68%) with a diagnoses of severe sepsis are
admitted to the medical floor, with a mortality rate around 26-29.5%. The diagnosis of severe
sepsis is not getting documented properly which is causing treating clinicians to not order the
appropriate antimicrobial agents, which can lead to worsening conditions and a reduction in
survival. As of September 2015, sepsis has become a core measure for CMS and sepsis outcomes
will be a part of the pay for performance initiatives, therefore the better hospitals perform on the
measure the more money they will be reimbursed The current data available for sepsis and severe sepsis according to the Agency for
Healthcare Research and Quality (AHRQ) shows that hospitals with a high volume of sepsis
admissions have the lowest mortality rates (March 2011, No. 367). Researches reviewed the
records of 87,166 adults with sepsis who were admitted to 551 hospitals after receiving care in
the emergency room. The hospitals were divided into quartiles based on the number of sepsis
patients they had treated. Researchers measured death occurring at any time during the patients
hospitalization and death during the first 2 days of admission. The inpatient mortality rate was
18.0 percent. The research showed that there were lower odds of inpatient death when patients
received appropriate care in the emergency room before their admission. (AHRQ archives,
March 2011, No. 367). Early detection and appropriate treatment is the key to survival.
Treatment for sepsis should be initiated in the emergency room where early recognition
and treatment decreases mortality. If sepsis is caught in its earliest stage it can be treated quickly
and effectively which will reduce the length of hospital stay and reduce cost to the patient and
the hospital. Andriolo, R. B., Atallah, Á. N., & Salomão, R. (2013). De-escalation of antimicrobial treatment
for adults with sepsis, severe sepsis or septic shock. Cochrane Database of Systematic
Reviews. doi:10.1002/14651858.cd007934.pub3
http://onlinelibrary.wiley.com.proxy.chamberlain.edu:8080/doi/10.1002/14651858.CD00
7934.pub3/full
Mayo Clinic (2016). Retrieved from http://www.mayoclinic.org/diseases
conditions/sepsis/home/ovc-20169784

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