Evidence-based care, culture change reduced sepsis, complications at NJ hospital

The blood infection sepsis and its cascading effects on the body can seriously complicate a patient's prognosis and increase the cost of their hospital stay several times over.

But New Jersey's Kennedy Health System undertook a multilevel, multidepartmental plan to fight sepsis in its emergency department and intensive care unit and successfully reduced sepsis and its resultant complications, including patient mortality, according to an article at the American Hospital Association (AHA) News. The plan followed an evidence-based care model that involved constantly reviewing patient data and adapting care as needed.

Sepsis is responsible for half of all hospital deaths and contributes to readmissions at rates comparable to heart failure and pneumonia. Part of what complicates sepsis prevention and treatment is that is "multijurisdictional." In other words, it's unclear whether to classify it as a surgical complication or a hospital-acquired infection (HAI). 

Kennedy researchers tackled the problem by instituting system-wide changes to hospital culture, constantly reviewing data from multiple departments and implementing new processes. Evidence-based care was central to the approach and precipitated a cultural shift within the organization away from blame and punitive measures and toward collaboration and collective action, according to the article.

The study--which began in 2012 and continued through 2015--found that nursing staff were not getting timely orders for lactate tests and therefore sepsis wasn't getting detected until it was already in its later stages. Now, nurses may order the tests themselves when patients show early signs of inflammation and infection associated with sepsis.

"It's all about the patient, not the caregiver," Marianne Kraemer, R.N., who co-chaired the committee, told the publication. "We focus on the lessons learned and nothing is punitive. The idea is to set processes and then get better at them." 

As a result of the Kennedy program, the mortality rate due to sepsis has been lowered to 11.9 percent. Some 93.9 percent of diagnoses cases received more timely and effective treatment and an estimated 130.4 lives have been saved, according to the article.

To learn more:
- read the AHA News article