A novel program implemented across the Emergency Department and all inpatient units at The Mount Sinai Hospital is being credited with helping the hospital achieve a three-year reduction in sepsis mortality.
The “Stop Sepsis Program” is based upon a project developed in 2011 by the Department of Emergency Medicine and the Division of Pulmonary, Critical Care and Sleep Medicine to enhance the early identification and management of patients with suspected sepsis, a condition that results from infection and can quickly become life-threatening when it impairs blood flow to organs.
“More cases of sepsis are now being recognized earlier, and the number of deaths being attributed to sepsis is decreasing,” says Charles A. Powell, MD, Chief of the Catherine and Henry J. Gaisman Division of Pulmonary, Critical Care and Sleep Medicine, and the Janice and Coleman Rabin Professor of Pulmonary Medicine. Dr. Powell is leading the hospitalwide “Stop Sepsis Program” collaboratively with the Office for Excellence in Patient Care, and teams of physicians and nurses.
The hospital’s baseline sepsis mortality rate in 2011 was 31.2 percent, but through process improvements and program expansion, it has decreased to 15.4 percent during the first half of 2014. The program’s goal is to achieve a 13 percent sepsis mortality rate for 2014.
Increased sepsis vigilance likely helped save at least 76 lives in 2012, and 93 lives in 2013, and the hospital is on track to save more than 150 lives this year. Mount Sinai Queens has also adopted the “Stop Sepsis Program,” and in the future, elements of the program will be adapted across the Mount Sinai Health System.
“The sepsis program has fostered an enhanced collaborative team approach among nurses, sepsis nurse practitioners, and physicians, resulting in better quality of care and improved patient outcomes,” says Vicki LoPachin, MD, Chief Medical Officer of The Mount Sinai Hospital, and the executive sponsor of the program.The program depends upon early recognition of symptoms by nurses who complete a sepsis screening, and is guided by a vital-sign tracking and notification tool within the Epic electronic health record system. A positive screening combined with abnormal vital signs, such as fever and increased respiratory and heart rates, will trigger an alert in Epic to escalate care. A team of physicians and specially trained Sepsis Nurse Practitioners further assess the patient and begin aggressive sepsis care as appropriate. Physician and Nursing Sepsis Champions from 20 service areas review all of the suspected cases of severe sepsis and adherence to the hospital’s protocol, providing continued feedback on outcomes and opportunities for improvement.
According to Judy Miranda, RN, Nursing Director, Transplant, and Rehabilitation Medicine, “We have created not only a culture of patient-centered care, but a learning environment for our nurses and physicians, all with the goal of providing exceptional care.”
Adds Scott Lorin, MD, Associate Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine), Director of the Medical Intensive Care Unit, and a program leader: “This program is successful because of its data-driven, multidisciplinary approach to implementation, evaluation, and improvement. Ultimately, it is gratifying to know that this benefits our patients.”