Background
Hospitals implement a variety of practices to identify, prioritize, and treat patients presenting to the Emergency Department (ED) with sepsis. We sought to understand what strategies were utilized and if any were associated with improved processes.
Methods
69 hospitals participating in the Michigan Hospital Medicine Safety Consortium (HMS) Sepsis Initiative, a collaborative quality initiative sponsored by BCBSM, were surveyed in Fall 2023 about their ED sepsis strategies. Free-text responses were coded using inductive thematic analysis. Hospitals were sorted into quintiles of performance on process measures (e.g., ED length of stay (LOS), time-to-antibiotics) using HMS-sepsis registry data. Strategies used by >10% of hospitals were tested for association with processes.
Results
63 (91.3%) hospitals completed the survey. The most common strategies used to identify sepsis were sepsis screening tools (39.7%), electronic health record (EHR) alerts (33.3%), and nurse-initiated processes (23.8%). The most common triage or prioritization strategies were nurse-initiated prioritization (39.7%), Emergency Severity Index score (22.2%), and code sepsis protocols (14.3%). 40 hospitals (63.5%) had made changes to their ED triage system in the prior two years. The most common changes were sepsis education (22.2%), new/revised EHR alerts (17.4%), and a new/updated order sets (12.7%). Use of a nurse-initiated prioritization strategy was associated with shorter ED LOS; this strategy of was used at 50.0%, 44.7%, and 7.7% of hospitals in the top quintile, middle three, and bottom quintiles for ED LOS respectively, p=0.03. A sepsis screening tool was used 66.7%, 42.1%, and 23.1% of hospitals in the top, middle three, and bottom quintiles of time-to-antibiotics in patients with hypotension, p=0.105.
Conclusions
Michigan hospitals use a variety of strategies for identifying and prioritizing patients with sepsis, with a majority implementing new strategies in the past two years. Nurse-initiated prioritization and a sepsis screening tool may enhance timely treatment and ED throughput.
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