Team training and hands-on practice are important for stopping the number one enemy in hospitals.
By Tina Schade Willis, M.D.
I never thought about how one of the most common medical terms in my daily work is a foreign term to most of my patients and families. That is, until sepsis threatens the life of their loved one or child. Then the word is all too familiar and certainly never forgotten. It's one of the most humbling diagnoses in medicine and can take a healthy child from playful one moment to death the next.
Recently, I reviewed one of our sepsis cases at UNC Children's Hospital and saw what I hope will be our new normal. A high-risk inpatient developed a sudden fever and slightly elevated heart rate. Providers assessed him and recognized it was more than just a fever. They diagnosed severe sepsis immediately and completed the placement of additional access, administered the first rapid fluid bolus, obtained cultures and labs, and had antibiotics to the bedside within 10 minutes, prior to the sepsis team's arrival.
While this patient had a positive outcome, it's frightening to think that sepsis is the most common diagnosis associated with inpatient deaths, and therefore the number one enemy in hospitals. As a pediatric intensivist and sepsis expert, I thought I recognized and responded to it in a timely and evidence-based manner. Research shows most experts feel they're doing a good job, but sepsis can be subtle and go unrecognized. Even when diagnosed, we take hours to complete the evidence-based bundle care elements that, when approached as a team with standardized processes, can be done in a matter of minutes. Knowing guidelines and trying harder is not good enough; countless patients are dying from sepsis in hospitals across the country every day.
Nearly two years ago, my institution committed to decreasing preventable hospital deaths from sepsis in all ages. This work focuses on improving outcomes we've never approached before, including aggressive education, recognition and treatment programs featuring simulation training, changes to the EMR and multidisciplinary action teams for every age group.
UNC Children's Hospital is leading the program because it's a smaller scale hospital within a larger system and can apply small tests of change to a foundation of teamwork training and standard processes. We have a history of partnering with family advisors in the design of improvement initiatives and use that experience to include patient and family advisors in the adult sepsis programs. UNC Children's often has more in common with the adult patient care areas than not, and this collaborative approach increases the organization's abilities to succeed in tool development, shared educational experiences and resources.
The most critical lesson I've learned is the importance of team training and hands-on practice. Several of the most successful areas are without screening tools or EMR prompts. Instead, those areas have been practicing sepsis recognition, are encouraged to speak up and call a “code sepsis,” and complete the bundle prior to the arrival of the sepsis experts or rapid response team. This was accomplished through practice, including the use of techniques for rapid fluid administration, starting additional intravenous access points and knowing which antibiotics can be pushed and given first, and which need to be infused over a longer period.
Empowering clinical staff members to use and build upon their skills, and advocate for patients, is something we should continue to champion. Everyone owns a part of sepsis prevention, detection and treatment. It requires teamwork, empowerment and accountability; things no automated best practice alert can replace.
Tina Schade Willis, M.D., is associate director of the UNC Institute for Healthcare Quality Improvement. She serves on CHA's Improving Pediatric Sepsis Outcomes National Expert Advisory Committee. Send questions or comments to firstname.lastname@example.org.