Utilizing a multi-faceted approach to improve 6-hour bundle compliance of patients with severe sepsis and septic shock

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Gabbard, E. (2015). Utilizing a multi-faceted approach to improve 6-hour bundle compliance of patients with severe sepsis and septic shock. Unc Charlotte Electronic Theses And Dissertations.
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Abstract

Purpose: The purpose of this DNP Scholarly Project was to evaluate the impact of Virtual Critical Care (VCC) and Sepsis Program Coordinators on 6 hour bundle compliance (divided into 3 time frames: first 3 hour, second 3 hour, and total 6 hour) for patients with severe sepsis and septic shock following the Society of Critical Care Medicine's Surviving Sepsis Campaign Guidelines. Background: Severe sepsis and septic shock is defined as a systemic infection leading to massive widespread vasodilation and poor tissue perfusion resulting in organ dysfunction and death. While cases have tripled in the last twenty years, mortality among this patient population remains approximately 25%. Through the use of the Surviving Sepsis Guidelines, a bundled approach to care for this population focuses on timely antibiotics, intravenous volume replacement, and invasive hemodynamic monitoring. Methods: This is a pre and post measure of an intervention designed to improve adherence to the standard of care for the patient with severe sepsis and septic shock, defined as Code Sepsis. Data was collected from December 1st 2013 to December 31st 2014 on Code Sepsis patients admitted to the intensive care unit at nine different hospitals. A total of 1806 patients met the inclusion criteria. Results: Results demonstrated a statistically significant improvement in first 3 hour bundle compliance (6.4%, 95% CI 1.6-11.3%), p-value = 0.01., second 3 hour bundle compliance (6.2%, 95% CI 2.7-9.7%), p-value = 0.001 and total 6 hour bundle compliance (4.2%, 95% CI 1.5-6.9%), p-value=0.003. Approximately 45 readmissions were prevented with a cost avoidance of $290,619, and among the survivors, it was demonstrated that the intervention group avoided 1,011 hospital days for a cost avoidance of $374,088. In addition, there was a reported reduction in mortality by 8.3% (95% CI 4.5% to 12.2%) p-value < .0001, which demonstrated a total of 80 lives saved. Implications for Practice: This supports current literature that a coordinated, systematic approach improves bundle compliance and reduces hospital length of stay, readmission, and mortality.

Details
Author

Gabbard, Erika

Title

Utilizing a multi-faceted approach to improve 6-hour bundle compliance of patients with severe sepsis and septic shock

Physical Description

1 online resource (47 pages) : PDF

Date

2015

Degree Granting Institution

University of North Carolina at Charlotte

Abstract

Purpose: The purpose of this DNP Scholarly Project was to evaluate the impact of Virtual Critical Care (VCC) and Sepsis Program Coordinators on 6 hour bundle compliance (divided into 3 time frames: first 3 hour, second 3 hour, and total 6 hour) for patients with severe sepsis and septic shock following the Society of Critical Care Medicine's Surviving Sepsis Campaign Guidelines. Background: Severe sepsis and septic shock is defined as a systemic infection leading to massive widespread vasodilation and poor tissue perfusion resulting in organ dysfunction and death. While cases have tripled in the last twenty years, mortality among this patient population remains approximately 25%. Through the use of the Surviving Sepsis Guidelines, a bundled approach to care for this population focuses on timely antibiotics, intravenous volume replacement, and invasive hemodynamic monitoring. Methods: This is a pre and post measure of an intervention designed to improve adherence to the standard of care for the patient with severe sepsis and septic shock, defined as Code Sepsis. Data was collected from December 1st 2013 to December 31st 2014 on Code Sepsis patients admitted to the intensive care unit at nine different hospitals. A total of 1806 patients met the inclusion criteria. Results: Results demonstrated a statistically significant improvement in first 3 hour bundle compliance (6.4%, 95% CI 1.6-11.3%), p-value = 0.01., second 3 hour bundle compliance (6.2%, 95% CI 2.7-9.7%), p-value = 0.001 and total 6 hour bundle compliance (4.2%, 95% CI 1.5-6.9%), p-value=0.003. Approximately 45 readmissions were prevented with a cost avoidance of $290,619, and among the survivors, it was demonstrated that the intervention group avoided 1,011 hospital days for a cost avoidance of $374,088. In addition, there was a reported reduction in mortality by 8.3% (95% CI 4.5% to 12.2%) p-value < .0001, which demonstrated a total of 80 lives saved. Implications for Practice: This supports current literature that a coordinated, systematic approach improves bundle compliance and reduces hospital length of stay, readmission, and mortality.

Genre

doctoral dissertations

Subjects--Topics

Nursing
Medicine

Degree

Ph.D.

Keywords

Sepsis
Telemedicine

Subject Area

Health Services Research

Advisor(s)

Langford, David

Committee Members

Heffner, Alan
Taylor, Dennis
Powers, Kelly
Burton, Hughlene

Degree Note

Thesis (Ph.D.)--University of North Carolina at Charlotte, 2015.

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Rights Holder Information

Copyright is held by the author unless otherwise indicated.

Identifier

Gabbard_uncc_0694D_10803

Permalink

http://hdl.handle.net/20.500.13093/etd:879