Clinical and Economic Impact of a Quality Improvement Initiative to Enhance Early Recognition and Treatment of Sepsis
Abstract
Background: Studies evaluating the clinical effectiveness of sepsis screening tools and methods to improve the time from diagnosis to antibiotic administration are needed to improve sepsis-related outcomes. Objective: To evaluate the clinical and economic impact of a sepsis quality improvement initiative to improve early recognition and treatment of sepsis. Methods: A retrospective observational study of adults with sepsis was performed in a 433-bed tertiary medical center. Baseline data were collected for 181 patients with sepsis diagnosis-related group (DRG) coding assignments from July through September 2013. The intervnetion group included 216 patients from October through December 2013. A First-Dose STAT Antibiotic policy was developed, and nurses were instructed to complete an electronic sepsis screening tool once per shift. Primary outcomes included in-hospital mortality and intensive care unit (ICU) length of stay (LOS). Secondary outcomes included overall LOS and cost per case. Results: Nonsignificant decreases in overall LOS (7.43 ± 5.68 days vs 6.77 ± 5 days; P = 0.138) and in-hospital mortality (13.8% vs 8.8%; P = 0.113) were observed in patients with sepsis DRGs. Early recognition and treatment contributed to significant reductions in ICU LOS (5.85 ± 4.38 days vs 4.21 ± 3.64 days; P = 0.003) and total cost per case ($14 378 vs $12 311; P = 0.033). The percentage of highest disease-severity DRG coding assignments decreased from 7.9% to 0%. Conclusions: Strategies to improve early recognition and treatment of sepsis, including routine use of an electronic sepsis screening tool and implementation of a First-Dose STAT Antibiotic policy, contributed to significant reductions in ICU LOS and cost per case.
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Nineteen studies were ex-post economic evaluations; of those, 17 were cost-effectiveness analyses.
“Nineteen studies were ex-post economic evaluations of which 17 were CEAs with one CUA [7, 12, 14, 15, 17] [18–30, 33].”
From Use of health economic evaluation in the implementation and improvement science fields—a systematic literature review (2019) · cites this paper as [18]
Cites
Early goal-directed therapy in the treatment of severe sepsis and septic shock
Rivers, E., Nguyen, B., Havstad, S., Ressler, J., Muzzin, A., Knoblich, B., Peterson, E., & Tomlanovich, M. (2001) · New England Journal of Medicine · doi:10.1056/nejmoa010307 · Cited by 10,743 · see citing works
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock
Dellinger, R. P., Levy, M. M., Rhodes, A., Annane, D., Gerlach, H., Opal, S. M., Sevransky, J. E., Sprung, C. L., Douglas, I. S., Jaeschke, R., et al. (2013) · Critical Care Medicine · doi:10.1097/ccm.0b013e31827e83af · Cited by 9,694 · see citing works
Kumar, A., Roberts, D., Wood, K. E., Light, B., Parrillo, J. E., Sharma, S., Suppes, R., Feinstein, D., Zanotti, S., Taiberg, L., et al. (2006) · Critical Care Medicine · doi:10.1097/01.ccm.0000217961.75225.e9 · Cited by 6,109 · see citing works
A randomized trial of protocol-based care for early septic shock.
The ProCESS Investigators (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1401602 · Cited by 2,414 · see citing works
Morrell, M., Fraser, V. J., & Kollef, M. H. (2005) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.49.9.3640-3645.2005 · Cited by 1,286 · see citing works
Garey, K. W., Rege, M., Pai, M. P., Mingo, D. E., Suda, K. J., Turpin, R. S., & Bearden, D. T. (2006) · Clinical Infectious Diseases · doi:10.1086/504810 · Cited by 1,171 · see citing works
Levy, M. M., Dellinger, R. P., Townsend, S. R., Linde‐Zwirble, W. T., Marshall, J. C., Bion, J., Schorr, C., Artigas, A., Ramsay, G., Beale, R. J., et al. (2010) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181cb0cdc · Cited by 951 · see citing works
Castellanos-Ortega, Á., Suberviola, B., García-Astudillo, L. A., Holanda, M. S., Ortiz, F., Llorca, J., & Delgado‐Rodríguez, M. (2010) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181d455b6 · Cited by 360 · see citing works
Multicenter Implementation of a Severe Sepsis and Septic Shock Treatment Bundle
Miller, R. R., Li, D., Nelson, N. C., Brown, S. M., Kuttler, K. G., Probst, D. R., Allen, T. L., & Clemmer, T. P. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201212-2199oc · Cited by 257 · see citing works
Bloos, F., Thomas-Rüddel, D., Rüddel, H., Engel, C., Schwarzkopf, D., Marshall, J. C., Harbarth, S., Simon, P., Riessen, R., Keh, D., et al. (2014) · Critical Care · doi:10.1186/cc13755 · Cited by 240 · see citing works
Validation of a Screening Tool for the Early Identification of Sepsis
Moore, L. J., Jones, S. L., Kreiner, L. A., McKinley, B. A., Sucher, J. F., Todd, S., Turner, K. L., Valdivia, A., & Moore, F. A. (2009) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0b013e3181a3ac4b · Cited by 135 · see citing works
Hospital Case Volume and Outcomes among Patients Hospitalized with Severe Sepsis
Walkey, A. J., & Wiener, R. S. (2014) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201311-1967oc · Cited by 93 · see citing works
Rivers, E. P., & Ahrens, T. S. (2008) · Critical Care Clinics · doi:10.1016/j.ccc.2008.04.002 · Cited by 78 · see citing works
Physician Impact on the Total Cost of Care
Taheri, P. A., Butz, D. A., Griffes, L. C., et al. (2000) · Annals of Surgery · doi:10.1097/00000658-200003000-00017 · Cited by 74 · see citing works
Computer versus paper system for recognition and management of sepsis in surgical intensive care
Croft, C. A., Moore, F. A., Efron, P. A., Marker, P. S., Gabrielli, A., Westhoff, L., Lottenberg, L. L., Jordan, J. R., Klink, V., Sailors, R. M., et al. (2014) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0000000000000121 · Cited by 60 · see citing works
Patocka, C., Turner, J., Xue, X., & Segal, E. (2013) · Journal for Healthcare Quality · doi:10.1111/jhq.12055 · Cited by 22 · see citing works
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Roberts, S. L. E., Healey, A., & Sevdalis, N. (2019) · Implementation Science · doi:10.1186/s13012-019-0901-7 · Cited by 161 · see citing works
- Authors
- Judd, W. R., Stephens, D. M., & Kennedy, C. A.
- Affiliations
- Saint Joseph Hospital, Lexington, KY, USA
- Venue
- Annals of Pharmacotherapy
- Publisher
- SAGE Publications
- Published
- 2014-06-30
- Volume
- 48
- Issue
- 10
- Pages
- 1269-1275
- ISSN
- 0012-6578 (ISSN-L)
- 1060-0280
- 1542-6270
- OpenAlex
- W2140052215
- Cited by
- 35
- References
- 16
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 5 · 2018: 7 · 2017: 3 · 2016: 3 · 2015: 2
- FWCI
- 2.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Pharmacotherapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Keywords
- sepsis, early recognition, sepsis screening tools, timing of antibiotic administration, ICU length of stay, in-hospital mortality, health care costs, quality improvement, diagnosis-related groups, electronic health records
- MeSH terms
- Adult, Anti-Bacterial Agents, Diagnosis-Related Groups, Hospital Bed Capacity, 300 to 499, Humans, Intensive Care Units, Length of Stay, Retrospective Studies, Cost Savings, Hospital Mortality, Sepsis, Quality Improvement, Tertiary Care Centers
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