Why sepsis screening isn't one-size-fits-all

Sepsis is difficult to recognize, and a delayed diagnosis can have tragic consequences. Every hour a patient in septic shock doesn't receive antibiotics, the risk of death increases by 7.6%. 

This translates into incredibly high mortality rates. In 2008, only 2% of hospital patients were diagnosed with sepsis, but it was responsible for 17% of hospital deaths.

“Every hour a patient in septic shock doesn't receive antibiotics, the risk of death increases 7.6%”

There is reason for optimism. Some organizations have consistently achieved better sepsis mortality outcomes than others. But what are these top performers doing differently?

High-performers recognize the critical importance of early detection and use identification protocols to catch sepsis early. This probably isn't surprising, but there is an important nuance to the strategies they use. 

A one-size-fits-all approach to sepsis screening does not work across all points of care. Instead, organizations should tailor identification strategies to the ED, inpatient units, and ICU to account for factors like sepsis patient volumes, screening feasibility, and patient acuity.

We put together three tips to help you customize your sepsis screening strategies to different points of care.

1. Prioritize universal sepsis screening in the ED.
83% of sepsis patients already have sepsis upon admission, meaning the vast majority of your patients with sepsis are coming in through the ED. It's also likely that you could be identifying more patients there—average organizations identify 13.8 sepsis cases per 1000 ED visits, while the bottom quartile of organizations only identify 6.5 sepsis cases. 

The ED is the best opportunity to catch sepsis patients early, so we recommend casting a wide net and screening every patient during triage for symptoms of infection. For patients with a suspected infection, nurses should follow-up with a more thorough SIRS evaluation.

2. Equip floor nurses with clear criteria to identify emerging sepsis symptoms.
Floor sepsis screening needs to balance two competing aims: respecting the already full workload of nurses, and enabling nurses to detect subtle signs of sepsis. 

To do this, we recommend educating nurses and providing them with explicit symptom criteria that prompt a more thorough evaluation. St. John’s Hospital in Minnesota gives nurses sepsis criteria index cards as a visual reminder to look out for sepsis.

3. Build sepsis screening in ICU that accounts for high patient acuity.
Because ICU patients are critically ill, many will meet the sepsis screening criteria (e.g., SIRS) even if they don’t have sepsis. To reduce these false alarms, Wake Forest Baptist Health assigns a “snooze phase” to each ICU patient depending on their treatment. This means nurses won’t call code sepsis during the “snooze phase” because patients are likely to meet the SIRS criteria.

Additionally, clinicians should be particularly vigilant with geriatric patients since they are 13 times more likely to get sepsis—and have a mortality rate over 40%.

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Reducing Sepsis Mortality at Wake Forest Baptist

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