The Impact of continuous training & education on Sepsis, improving quality of care, treatment and prognosis of patients.
Sepsis remains the leading cause of morbidity and mortality to date, claiming more lives than lung, breast, bowel cancer and HIV/Aids combined. Sepsis recognition is crucial in the early stages as it can hugely impact the prognosis of patients presenting with sepsis.
Portiuncula University Hospital (PUH) Sepsis representatives and Emergency Department (ED)developed a continuous education system incorporating the revised 3rd International Consensus for Sepsis definitions for our entire hospital including the senior hospital management, nurses, health-care assistants, and the inpatient teams. The objective was to form a dedicated continuous teaching system whereby Awareness to Sepsis could result in better recognition, quicker response, and immediate escalation and improve outcomes for our patients as alluded to in previous ED research.
In a study period of 1 year, 6 months and 16 days, data was compared between 2 set periods: July 2016 - September 2016(3 months) and September 2017 - February 2018(5 months). Between the first Study and the Second, awareness was raised through daily and weekly teachings, poster prompts and implementation of National Sepsis protocols. Additionally, lectures were presented at grand rounds and induction day to all hospital staff.
This double-blinded prospective study analyzed the recognition process, sepsis pathways, protocols, the management, efficiency of escalation, and prognosis of septic patients based on the diagnostic criteria for sepsis by the 3rd International Sepsis Consensus. Sepsis screening forms were put into use and highlighted as a risk stratification system for Sepsis Recognition using both the elements of SIRS and QSoFA score. 79(1):148(2) patients satisfied the Sepsis criteria and their charts were analyzed with data recorded. The main elements studied include Recognition of sepsis in triage, Completion of Sepsis6 bundle, class of antibiotics prescribed, adherence to Antimicrobial guideline prescription, average time taken for treatment, Lab investigations, blood culture result and imaging, sepsis prevalence, mortality and appropriate escalation data.
146 patients were included in this study. At triage 122 sepsis cases were recognized (83.56%, CI 122:146) [↑29.56%, 54%:83.56%]. Patient Appropriately triaged to priority 2 were 133 (91.09%, CI 133:146) [↑1.29%, 89.8%:91.09%]. The mean time that septic patients are seen from the time of registration records at 36.57 minutes [↓2.6min, 39.17: 36.57]. Sepsis6 completion with patients presenting with sepsis (100% CI,146:146). 142 out of 146 Antibiotics prescribed were adhering to guidelines (97.26%, 142:146) [↑ 6.26%,91;97.26%]. The study reported a 100% escalated care in terms of referral to the appropriate departments (100%, 146:146). ICU admissions were 54 in total (36.98%, 54:146). There were no mortalities resulting from sepsis in the ED during the term of the study.
This study demonstrated a vast improvement of recognition and management of sepsis in the Emergency Department. The impact of continuous education and training combined with a dedicated and committed management team to ensure quality patient-centered care according to best practice guidelines can achieve targeted goals.
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