Executive Summary Checklist
- For sepsis, implement processes for rapid assessment and intervention at the bedside and initiate sepsis bundle (surviving sepsis campaign 3-hour element).
- For septic shock, implement processes for rapid assessment, intervention, and need for higher level of care and initiate septic shock bundle (surviving sepsis campaign 6-hour elements).
- For those who can acquire electronic systems:
- Acquire electronic systems to facilitate data collection and screening for sepsis.
- Implement an automated system for electronic screening and documentation of the process of care based on existing data. This may involve using SIRS criteria, MEWS, qSOFA, or any other warning system being used.
- Implement a process for continuous monitoring of electronic systems and protocols.
- Compliance, efficacy and outcome measures.
- Design a workflow specific to level of alert.
- Screening: SIRS/Sepsis/Septic shock workflow.
- Mortality prediction: Early Warning Score e.g. Universal Vital Assessment, MEWS or qSOFA (or "Level of Risk") .
- Implement case reviews when cases are not managed well or when outcomes are poor e.g. mortality, intensive care admission, prolonged stay in the hospital.
The Sepsis Improvement Gap
In May 2017, the World Health Assembly passed a resolution to improve sepsis care. Sepsis is now recognized as a global priority with significant public health impact. However, huge variation exists between high-income countries (HIC) and low and middle-income countries (LMIC) and their programmatic approaches to improving sepsis care.
This document is intended for use by healthcare administrators and clinical leaders to support sustainable improvements in the health system’s approach to the management of sepsis. It is divided into 3 sections:
- What is sepsis and why is it important?
- How to use a quality improvement approach to improve sepsis management?
- How to use resources and tools to support sepsis improvement programs?
What is sepsis and why is it important to you?
What is sepsis?
In simple terms, patients with sepsis are patients who are seriously ill with infection and likely to die or be admitted to the intensive care setting as a result. Sepsis arises when the body’s response to infection injures its own tissues and organs. It can lead to septic shock, multiple organ failure and death, if not recognized early and managed promptly. It is a major cause of morbidity and mortality in all populations living in LMICs, including the most vulnerable such as pregnant women, neonates and young children. Sepsis can result from severe infections with bacteria, viruses, fungi or parasites; it is their common pathway to death. A person can develop sepsis in the community (such as community acquired pneumonia) or in the hospital (such as nosocomial infection). Sepsis can also develop when infections are from dangerous, emerging infectious diseases (such as viral hemorrhagic fevers).
What is burden of sepsis?