Improving sepsis recognition and treatment in a Montana critical access hospital: a quality improvement initiative

Abstract

Background: Sepsis is an illness caused by body dysregulation in response to an infection, and it affects 30 million people globally each year. In the United States, sepsis accounts for nearly one-third of all hospital deaths, and 1.7 million Americans are treated for sepsis and septic shock annually. Local Problem: Rurality is associated with higher sepsis mortality rates. Nearly one-half of Montana's population lives in rural areas. Rural hospitals often fall behind in sepsis care delivery due to insufficient resources and limited knowledge related to low case volumes. A rural critical access hospital (CAH) in Montana experienced delays in treatment and a 15% case fatality rate over a 2-year period. Methods: To reduce delays in sepsis recognition and treatment, evidence-based screening tools and published standards of care for the treatment of sepsis were implemented. Interventions: In-person education was provided for all CAH staff. The modified early warning score (MEWS) and systemic inflammatory response syndrome (SIRS) criteria were implemented into practice and the electronic health record (EHR). A nurse-driven protocol and provider order set were created and implemented to promote early diagnostic evaluation. Results: Education improved overall confidence and competence in providing sepsis care. 12 sepsis cases were identified in a 7-week period using MEWS/SIRS. The nurse-driven protocol was implemented in 9 cases, which includes interventions for sepsis evaluation. All cases received antibiotics within guideline recommendations. Conclusion: Implementation of staff education, sepsis screening tools, and a nurse-driven protocol improved sepsis recognition and reduced treatment delays in a CAH.