ED Tracking Sheet Implementation

Study Overview
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Brief Summary
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The purpose of this study is to assess whether implementation of an ED Sepsis Tracking Sheet effects the percentage of goal-directed sepsis criteria met in a tertiary care academic Emergency Department.

Detailed Description
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Sepsis remains a common cause of morbidity and mortality in the hospital setting. Accurate diagnosis and timely initiation of therapy are important drivers of patient-centered outcomes in sepsis management. Compliance with the core measures listed in the surviving sepsis campaign guidelines has been variable. An ED-specific Sepsis Tracking Sheet (STS) - a tool for implementing and documenting critical actions in sepsis management - was created at our institution by a team of physicians, nurses, and ED pharmacists. Dedicated ED pharmacists were instructed to fill this sheet within one hour of the sepsis-specific best practice advisory (BPA) being activated in the ED. Core measures associated with the one hour and three hour sepsis bundles were tracked and outcomes were compared pre- and post-implementation of the STS.

Official Title
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ED Tracking Sheet Implementation

Conditions
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Sepsis, Severe Sepsis, Systemic Inflammatory Response Syndrome

Intervention / Treatment
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* Procedure: ED Sepsis Tracking Sheet


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Over 18 years old Initially evaluated in the DHMC Lebanon Emergency Department Activated sepsis BPA upon initial presentation (triage history consistent with infection combined with 2 or more SIRS criteria? Are these the criteria that trigger our sepsis BPA?) Exclusion Criteria: Patients who are transferred to the DHMC Lebanon Emergency Department from another facility Patients with absent data regarding one or more of the goal-directed sepsis criteria Patients who did not initially meet criteria to trigger the sepsis BPA, but developed sepsis later in their hospital course

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Pre-intervention<br>Patients presenting to the Emergency Department meeting severe sepsis criteria prior to implementation of an ED Sepsis Tracking Sheet | |
| Experimental: Post-intervention<br>Patients presenting to the Emergency Department meeting severe sepsis criteria following implementation of an ED Sepsis Tracking Sheet | Procedure: ED Sepsis Tracking Sheet<br>* Implementation of an ED Sepsis Tracking Sheet. This sheet will track time of patient presentation, time of High-Acuity Medical Response (HAMR) page, time of bilateral 18g or larger IV access, time of initial lactate, time two sets of blood cultures were sent, time antibiotics were administered as well as which antibiotics and what dose, time initial IV fluid bolus was completed, time repeat lactate was sent, timing of post-IV-fluid bolus vital signs, as well as the presence of persistent hypotension following this IV fluid bolus and whether or not vasopressors were applied.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of goal-directed sepsis criteria met | Goal-directed sepsis criteria involve the following: 1) Was an initial lactate obtained? 2) Were two sets of blood cultures sent? 3) Were antibiotics given within one hour of identification of severe sepsis? 4) Was the patient given an initial IV fluid bolus? 5) Was a repeat lactate sent if the initial lactate was elevated? These five criteria will be assessed as met or not met for each patient. The total of met and not met criteria will be aggregated across patients. The percentage of goal-directed sepsis criteria met will be calculated as met criteria divided by the sum of met plus not met criteria. | Time of ED presentation to the time of in-hospital death or hospital discharge, approximately 2 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Length of hospital stay | Time of ED presentation to the time of in-hospital death or hospital discharge, measured in days. | Time of ED presentation to the time of in-hospital death or hospital discharge, approximately 2 weeks | 
| In-hospital mortality | Death attributed to any cause occurring at any time between the patient's ED presentation and hospital discharge. | Time of ED presentation to the time of in-hospital death or hospital discharge, approximately 2 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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CMS Compliance, ED Pharmacist