Maimonides Evening of Research

Nurse Winner

Tamar Motov, MSN, RN, CNL

A Code Sepsis Initiative to Improve Outcomes in Emergency Department Patients with Severe Sepsis and Septic Shock

Objectives

Early aggressive intervention in septic patients has been previously demonstrated to have a positive impact on patient outcomes. In March 2017, a “Code Sepsis” program was initiated in the Maimonides ED to alert staff regarding the critical nature of the patient’s condition, improve communication between nursing, physician, and pharmacy staff engaged in caring for the patient, and to ensure that a plan was in place for the successful completion of the government mandated 3 and 6-hour bundles. The objective of this study was to determine whether activating a Code Sepsis in the ED improved outcomes of patients with severe sepsis and septic shock.

Methods

We conducted a chart review of septic patients from March 2017 – June 2019 who had a lactate > 4mmol/liter. We compared patients for whom a Code Sepsis was initiated (group 1) vs those in which it was not (group 2) in regards to mortality rate, bundle compliance, vasopressor use, hospital length of stay (LOS), and revenue.

Results

A total of 680 patients (274 in group 1 and 406 in group 2) met inclusion criteria. The demographic characteristics were similar in both groups; 53% male, mean 75 years old (P>.05). In both groups, approximately 27% required vasopressors (P=.719). Compliance with 3 and 6 hour bundle requirements in group 1 and 2 were (76% vs, 70%; P=.076) and (51% vs. 37%; P<.0001), respectively. The hospital LOS was 2 days longer for group 2; 9.2 days for group 1 and 11.1 days for group 2 (P=.314), and 29% of group 1 vs. 35% of group 2 expired in the hospital (P=.139). The mean total cost for group 1 was $27,503 vs. $32,170 for group 2 (P=.188). The mean total reimbursement for group 1 was $32,276 vs. $37,316 for group 2 (P<.05). Thus, group 2 revenue on average was $373 more per patient than group 1.

Conclusion Implication

Patients in the Code Sepsis group had greater compliance with the 6 hour bundle. Mortality rates and LOS were also improved, although these did not reach statistical significance. However, the total revenue was slightly greater in the no Code Sepsis group.