Recognizing Sick Sooner

Purpose:

In April 2014, based on comparative data with our partner hospitals, we realized that our organizational mortality rate from sepsis was unacceptable.  We wanted to accomplish the impossible….have an immediate and measurable reduction in morbidity and mortality caused by sepsis and septic shock.

Methods:

To reduce the amount of patients that would prove to be “false positive” in our sepsis screen, the ED decided to implement a modified version of SUPER SIRS criteria.  In order to expedite door to provider and door to treatment time; we educated all physician and nursing staff in the modified SUPER SIRS criteria; which is:  a patient with a new or unexplained mental status change and/or a suspected or known source of infection, AND any 2 of the following: systolic BP <90, respirations >24, heart rate >120, temperature of >38.3c or<36.0c.

Results: We had unexpected and exciting findings.  Within 6 months we were immediately able to improve our morbidity and mortality by over 50%.  However, a totally unanticipated finding; we realized that of all of the patients that met modified SUPER SIRS criteria, 99% were admitted, and with early identification, we were able to initiate treatment of other infectious and disease processed much earlier in the course of illness, and improve outcomes

Conclusion:

We realized that the utilization of modified SUPER SIRS has caused us to re-evaluate the benefit of very basic nursing skills, which are done by old fashioned assessment, and observation.  Ultimately, we have realized and identified an opportunity to recognize sick sooner.