Impact of a Sepsis Quality Improvement Initiative on Clinical and Operational Outcomes

TL;DR

A sepsis quality improvement program reduced mortality and hospital stays by using standardized workflows and a new diagnostic test.

Contribution

Demonstrated the effectiveness of a nurse-driven sepsis learning health program with a novel diagnostic test in improving outcomes.

Findings

Sepsis-associated mortality decreased from 10.9% to 6.6% after implementation.

Hospital length of stay was reduced by 0.76 days for sepsis DRG patients.

Blood culture use dropped from 50.8% to 45.7% among high-risk patients.

Abstract

Background/Objectives: Sepsis is a costly and life-threatening condition caused by a dysregulated host response to infection. Lack of a reliable, timely diagnostic for sepsis leads to under- and overdiagnosis, suboptimal outcomes, and strained hospital resources. Our Lady of the Lake Regional Medical Center (OLOLRMC) implemented a sepsis learning health program to evaluate and improve outcomes through standardized ED workflows and the incorporation of a novel sepsis diagnostic test. Methods: We report the results of the first year of experience following the implementation of the learning health initiative and sepsis testing. Data from the Epic EHR were analyzed across two groups: pre-implementation (April 2023–July 2023) vs. post-implementation (August 2023–July 2024), and temporally matched cohorts (April–July 2023 vs. April–July 2024). We assessed clinical outcomes (sepsis-associated mortality, hospital length of stay, or HLOS), and resource utilization (antibiotic use, blood cultures). Results: Post-implementation, sepsis-associated mortality dropped from 10.9% to 6.6% in the temporally matched group (p < 0.001). There was also a 0.76-day reduction in mean HLOS among sepsis DRG patients (p < 0.05). Blood culture utilization fell from 50.8% to 45.7%, driven by reductions in blood culture utilization among patients receiving a Band 1 IntelliSep score. Conclusions: The FMOLHS experience demonstrated significant benefits to patient outcomes and resource utilization after implementing a sepsis QI initiative including protocolized and standardized ED workflows via a nurse-driven triage system with sepsis testing for the early risk stratification of patients who present to the ED with signs and symptoms of infection.

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