Reductions in Sepsis Mortality and Costs After Design and Implementation of a Nurse-Based Early Recognition and Response Program

Research output: Contribution to journalArticle

Stephen L. Jones, Carol M. Ashton, Lisa Kiehne, Elizabeth Gigliotti, Charyl Bell-Gordon, Maureen Disbot, Faisal Masud, Beverly A. Shirkey, Nelda P. Wray

BACKGROUND: Sepsis is a leading cause of death, but evidence suggests that early recognition and prompt intervention can save lives. In 2005 Houston Methodist Hospital prioritized sepsis detection and management in its ICU. In late 2007, because of marginal effects on sepsis death rates, the focus shifted to designing a program that would be readily used by nurses and ensure early recognition of patients showing signs suspicious for sepsis, as well as the institution of prompt, evidence-based interventions to diagnose and treat it.

METHODS: The intervention had four components: organizational commitment and data-based leadership; development and integration of an early sepsis screening tool into the electronic health record; creation of screening and response protocols; and education and training of nurses. Twice-daily screening of patients on targeted units was conducted by bedside nurses; nurse practitioners initiated definitive treatment as indicated. Evaluation focused on extent of implementation, trends in inpatient mortality, and, for Medicare beneficiaries, a before-after (2008-2011) comparison of outcomes and costs. A federal grant in 2012 enabled expansion of the program.

RESULTS: By year 3 (2011) 33% of inpatients were screened (56,190 screens in 9,718 unique patients), up from 10% in year 1 (2009). Inpatient sepsis-associated death rates decreased from 29.7% in the preimplementation period (2006-2008) to 21.1% after implementation (2009-2014). Death rates and hospital costs for Medicare beneficiaries decreased from preimplementation levels without a compensatory increase in discharges to postacute care.

CONCLUSION: This program has been associated with lower inpatient death rates and costs. Further testing of the robustness and exportability of the program is under way.

Original languageEnglish (US)
Pages (from-to)483-491
Number of pages9
JournalJoint Commission journal on quality and patient safety / Joint Commission Resources
Volume41
Issue number11
StatePublished - Nov 1 2015

PMID: 26484679

Cite this

Standard

Reductions in Sepsis Mortality and Costs After Design and Implementation of a Nurse-Based Early Recognition and Response Program. / Jones, Stephen L.; Ashton, Carol M.; Kiehne, Lisa; Gigliotti, Elizabeth; Bell-Gordon, Charyl; Disbot, Maureen; Masud, Faisal; Shirkey, Beverly A.; Wray, Nelda P.

In: Joint Commission journal on quality and patient safety / Joint Commission Resources, Vol. 41, No. 11, 01.11.2015, p. 483-491.

Research output: Contribution to journalArticle

Harvard

Jones, SL, Ashton, CM, Kiehne, L, Gigliotti, E, Bell-Gordon, C, Disbot, M, Masud, F, Shirkey, BA & Wray, NP 2015, 'Reductions in Sepsis Mortality and Costs After Design and Implementation of a Nurse-Based Early Recognition and Response Program' Joint Commission journal on quality and patient safety / Joint Commission Resources, vol. 41, no. 11, pp. 483-491.

APA

Jones, S. L., Ashton, C. M., Kiehne, L., Gigliotti, E., Bell-Gordon, C., Disbot, M., ... Wray, N. P. (2015). Reductions in Sepsis Mortality and Costs After Design and Implementation of a Nurse-Based Early Recognition and Response Program. Joint Commission journal on quality and patient safety / Joint Commission Resources, 41(11), 483-491.

Vancouver

Jones SL, Ashton CM, Kiehne L, Gigliotti E, Bell-Gordon C, Disbot M et al. Reductions in Sepsis Mortality and Costs After Design and Implementation of a Nurse-Based Early Recognition and Response Program. Joint Commission journal on quality and patient safety / Joint Commission Resources. 2015 Nov 1;41(11):483-491.

Author

Jones, Stephen L. ; Ashton, Carol M. ; Kiehne, Lisa ; Gigliotti, Elizabeth ; Bell-Gordon, Charyl ; Disbot, Maureen ; Masud, Faisal ; Shirkey, Beverly A. ; Wray, Nelda P. / Reductions in Sepsis Mortality and Costs After Design and Implementation of a Nurse-Based Early Recognition and Response Program. In: Joint Commission journal on quality and patient safety / Joint Commission Resources. 2015 ; Vol. 41, No. 11. pp. 483-491.

BibTeX

@article{857c10b371c14df4aae8af155e840101,
title = "Reductions in Sepsis Mortality and Costs After Design and Implementation of a Nurse-Based Early Recognition and Response Program",
abstract = "BACKGROUND: Sepsis is a leading cause of death, but evidence suggests that early recognition and prompt intervention can save lives. In 2005 Houston Methodist Hospital prioritized sepsis detection and management in its ICU. In late 2007, because of marginal effects on sepsis death rates, the focus shifted to designing a program that would be readily used by nurses and ensure early recognition of patients showing signs suspicious for sepsis, as well as the institution of prompt, evidence-based interventions to diagnose and treat it.METHODS: The intervention had four components: organizational commitment and data-based leadership; development and integration of an early sepsis screening tool into the electronic health record; creation of screening and response protocols; and education and training of nurses. Twice-daily screening of patients on targeted units was conducted by bedside nurses; nurse practitioners initiated definitive treatment as indicated. Evaluation focused on extent of implementation, trends in inpatient mortality, and, for Medicare beneficiaries, a before-after (2008-2011) comparison of outcomes and costs. A federal grant in 2012 enabled expansion of the program.RESULTS: By year 3 (2011) 33{\%} of inpatients were screened (56,190 screens in 9,718 unique patients), up from 10{\%} in year 1 (2009). Inpatient sepsis-associated death rates decreased from 29.7{\%} in the preimplementation period (2006-2008) to 21.1{\%} after implementation (2009-2014). Death rates and hospital costs for Medicare beneficiaries decreased from preimplementation levels without a compensatory increase in discharges to postacute care.CONCLUSION: This program has been associated with lower inpatient death rates and costs. Further testing of the robustness and exportability of the program is under way.",
keywords = "Cost Savings, Electronic Health Records, Health Care Costs, Hospital Mortality, Humans, Intensive Care Units, Nursing Assessment, Organizational Innovation, Organizational Objectives, Patient Safety, Quality Assurance, Health Care, Quality Improvement, Sepsis, Texas",
author = "Jones, {Stephen L.} and Ashton, {Carol M.} and Lisa Kiehne and Elizabeth Gigliotti and Charyl Bell-Gordon and Maureen Disbot and Faisal Masud and Shirkey, {Beverly A.} and Wray, {Nelda P.}",
year = "2015",
month = "11",
day = "1",
language = "English (US)",
volume = "41",
pages = "483--491",
journal = "Jt Comm J Qual Patient Saf",
issn = "1553-7250",
publisher = "Joint Commission Resources, Inc.",
number = "11",

}

RIS

TY - JOUR

T1 - Reductions in Sepsis Mortality and Costs After Design and Implementation of a Nurse-Based Early Recognition and Response Program

AU - Jones, Stephen L.

AU - Ashton, Carol M.

AU - Kiehne, Lisa

AU - Gigliotti, Elizabeth

AU - Bell-Gordon, Charyl

AU - Disbot, Maureen

AU - Masud, Faisal

AU - Shirkey, Beverly A.

AU - Wray, Nelda P.

PY - 2015/11/1

Y1 - 2015/11/1

N2 - BACKGROUND: Sepsis is a leading cause of death, but evidence suggests that early recognition and prompt intervention can save lives. In 2005 Houston Methodist Hospital prioritized sepsis detection and management in its ICU. In late 2007, because of marginal effects on sepsis death rates, the focus shifted to designing a program that would be readily used by nurses and ensure early recognition of patients showing signs suspicious for sepsis, as well as the institution of prompt, evidence-based interventions to diagnose and treat it.METHODS: The intervention had four components: organizational commitment and data-based leadership; development and integration of an early sepsis screening tool into the electronic health record; creation of screening and response protocols; and education and training of nurses. Twice-daily screening of patients on targeted units was conducted by bedside nurses; nurse practitioners initiated definitive treatment as indicated. Evaluation focused on extent of implementation, trends in inpatient mortality, and, for Medicare beneficiaries, a before-after (2008-2011) comparison of outcomes and costs. A federal grant in 2012 enabled expansion of the program.RESULTS: By year 3 (2011) 33% of inpatients were screened (56,190 screens in 9,718 unique patients), up from 10% in year 1 (2009). Inpatient sepsis-associated death rates decreased from 29.7% in the preimplementation period (2006-2008) to 21.1% after implementation (2009-2014). Death rates and hospital costs for Medicare beneficiaries decreased from preimplementation levels without a compensatory increase in discharges to postacute care.CONCLUSION: This program has been associated with lower inpatient death rates and costs. Further testing of the robustness and exportability of the program is under way.

AB - BACKGROUND: Sepsis is a leading cause of death, but evidence suggests that early recognition and prompt intervention can save lives. In 2005 Houston Methodist Hospital prioritized sepsis detection and management in its ICU. In late 2007, because of marginal effects on sepsis death rates, the focus shifted to designing a program that would be readily used by nurses and ensure early recognition of patients showing signs suspicious for sepsis, as well as the institution of prompt, evidence-based interventions to diagnose and treat it.METHODS: The intervention had four components: organizational commitment and data-based leadership; development and integration of an early sepsis screening tool into the electronic health record; creation of screening and response protocols; and education and training of nurses. Twice-daily screening of patients on targeted units was conducted by bedside nurses; nurse practitioners initiated definitive treatment as indicated. Evaluation focused on extent of implementation, trends in inpatient mortality, and, for Medicare beneficiaries, a before-after (2008-2011) comparison of outcomes and costs. A federal grant in 2012 enabled expansion of the program.RESULTS: By year 3 (2011) 33% of inpatients were screened (56,190 screens in 9,718 unique patients), up from 10% in year 1 (2009). Inpatient sepsis-associated death rates decreased from 29.7% in the preimplementation period (2006-2008) to 21.1% after implementation (2009-2014). Death rates and hospital costs for Medicare beneficiaries decreased from preimplementation levels without a compensatory increase in discharges to postacute care.CONCLUSION: This program has been associated with lower inpatient death rates and costs. Further testing of the robustness and exportability of the program is under way.

KW - Cost Savings

KW - Electronic Health Records

KW - Health Care Costs

KW - Hospital Mortality

KW - Humans

KW - Intensive Care Units

KW - Nursing Assessment

KW - Organizational Innovation

KW - Organizational Objectives

KW - Patient Safety

KW - Quality Assurance, Health Care

KW - Quality Improvement

KW - Sepsis

KW - Texas

UR - http://www.scopus.com/inward/record.url?scp=84953344361&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84953344361&partnerID=8YFLogxK

M3 - Article

VL - 41

SP - 483

EP - 491

JO - Jt Comm J Qual Patient Saf

T2 - Jt Comm J Qual Patient Saf

JF - Jt Comm J Qual Patient Saf

SN - 1553-7250

IS - 11

ER -

ID: 18616771