Change Context:
This quality improvement project will be carried out in a large metropolitan emergency department with a patient turnover of about ninety thousand per a year. The department is comprised of both new and repeat emergency nurses as well as physicians’, nurse practitioners, and assistants. From the interviews, it emerged that because of the high patient turn-up and resultant fast pace environment, sepsis has been cited to be one of the areas that can be improved on especially because early identification and management were compromised by the nature of the health facility. Consequently, this project will aim at enhancing efforts to deal with sepsis in the emergency department.
Problem Description:
Sepsis is fatal in up to 30-50% of cases and constitutes a significant threat from infection leading to considerable healthcare costs both in terms of hospital expenditure where s is associated with 6.2% of total hospital costs in USA 2011(Arina & Singer, 2023).
Sepsis on the other hand is an extreme form of clinical sepsis that emanates from the body’s response to infection. Eradication of this disease has remained a challenge in the emergency department because it has up to 25% mortality. Sepsis is an increasingly recognized entity in the emergency department, contributing to significant morbidity and mortality in patients evaluated in this setting. However, current practices in management of sepsis suggest that many EDs continue to face challenges in identification, early treatment of sepsis. It may also mean to the patient delayed diagnosis, delayed access to treatment, longer hospital stays and therefore increased costs(Jayaprakash et al., 2024). Thus, there is a desperate need to address this issue further enhance sepsis care in the emergency department(Husabo et al., 2020).
Background literature defining the problem:
Many researchers have noted that sepsis may not be promptly identified by clinicians working in the emergency department. Hence, the study done by Singer et al. (2016) shows that for every hour that sepsis treatment is delayed, the risk of death rise to 4%. This underlines not only the fact of the need to identify sepsis in time and begin its therapy in the emergency department. However, Kim & Park, (2019) systematic review also highlights that sepsis protocols also confer benefits through reduced mortality and hospital stay. Such works prove the importance of increasing the quality of sepsis treatment in the emergency department and the changes that can take place in the patient’s condition, as a result.
Existing evidence on potential solutions to the problem:
While implementing sepsis bundles it was potential to identify several evidence-based strategies to facilitate the recognition and treatment of the disease in the emergency department. They range from sepsis screening tools, raising awareness, and imparting knowledge to the caregivers, integration of sepsis protocols and management through Rapid Response Teams(Melzer, 2019). It is evident that these interventions have an impact in the quality of sepsis care across different care environment. Consequently, adoption of the two models in the emergency department has the possibility of enhancing sepsis treatment and decreasing mortality.
Intervention:
The variation intended for this project is the utilize of sepsis screening tool as well as protocol in the emergency department. The assessment tool will assist in the process of determining patients who on arrival to the emergency department are sepsis prone. The protocol will then advise the kind of action to be taken by the health care provider depending on the risk class of the patient(Ramar & Gajic, 2013). The screening tool will be embedded into the EHR and will compel the assessing care provider to confirm the presence or absence of sepsis at the initial stage. The EGDT was meant for early identification of sepsis and targeted resuscitation through the continguous monitoring of ScvO2 (>70%), CVP (8-12mm Hg), MAP (≥65mm Hg) and urine output (> 0.5 mL/Kg/h). This protocolized treatment given to patients with severe sepsis or septic shock before they are admitted to ICU reduced modality of multi-organ dysfunction and overall decreased the rate of in-hospital mortality compared with standard care(Robinson, 2018).
However, three international multicentre trials: Protocolized Care for Early Septic Shock [ProCESS], Australasian Resuscitation in Sepsis Evaluation [ARISE], and Protocolized Management in Sepsis [ProMISe] were disappointing as failed to demonstrate any survival advantage of the protocolised care compared to standard practice. Additionally, within the meta-analysis of three individual participant data of RCTs, although the EGDT had no superior performance in effective clinical outcomes as compared to usual care, the intervention was found to be responsible for a higher hospital cost(Simon et al., 2022).
How will it work:
Sepsis screening tool will be a completed checklist of the criteria of sepsis such as vital signs, labs, and assessment findings(Vassiliou et al., 2017). If a patient will have two or more of the above criteria he will risk/sepsis. On EHR system a sepsis alert will pop up, and the protocol will be triggered. The protocol will entail some actions like; alerting the rapid response team, ordering required labs/imaging, and starting treatment such as antibiotics and fluids.
How will it be introduced/implemented into practice:
The sepsis screening tool and programme will be implemented through collaboration with the project team, the ED leaders, and the staffs. The screening tool and protocol will be undertaken and designed by the project team according to the current evidence regarding the best practices(Arina & Singer, 2023). ED leadership will be engaged in offering support and materials in the practice of the reform. This education and training will include a verbal explanation about the screening tool and protocol and why it is being introduced before its use during implementation. Some of the knowledge that will be produced will be the identification of sepsis criteria, protocol activation and interventional strategies(Beltrame & Anselmo, 2023).
Stakeholders and Engagement:
The members who will comprise the project team for this quality improvement initiative will comprise of leaders from the emergency department, the nursing staff, physicians, and IT support staff(Beltrame & Anselmo, 2023). It is essential to have a commitment from everyone, which is directly or indirectly involved in the activity of the project. The leaders in the emergency department will give their support and recommend the necessary factors needed for implementing the project together with factors that might hinder the process. The screening tool and protocol will be specifically created and will be initially designed by the nursing staff and physicians, who will also be expected to implement the tool in practice(Husabo et al., 2020). IT support will be also involved in executing the screening tool in the EHR system since they will be the first to notice if something is wrong or not working as planned.
Quality Improvement Methodology:
The Quality Improvement (QI) technique that will be used for this respective project is the Plan-Do-Study-Act (PDSA) cycle. The chosen strategy is the cycle that has been selected as the best from all that exist in the company. This method allows for the testing and implementation of changes in practice in sequential and cyclic fashion. This is made possible by the use of this methodology as pointed byJayaprakash et al., (2024). In order to obtain the first impression of the sepsis screening tool and procedure, the PDSA cycle will be used as the method. The following question will be posed Institutional Affiliation This inquiry will be conducted. As a way of ensuring that the full deployment is possible, this will be conducted on few patients as a pilot study. Finally, the findings of the pilot that was conducted in one of the EDs will be analyzed and any enhancement that has to be made in the overall measurement will then be used, before the choice is full taken and the tool and the method implemented across the emergency department wholly(Melzer, 2019). All this will happen before a decision is arrived at. Furthermore, through the use of this method, it will be possible to practice monitor and measure the tool and the protocol continuously and possibly implement changes to be made in subsequent PDSA cycles that have the potential to be implemented.
Outcomes/Analysis:
The goal of this project is primary enhanced recognition of sepsis and timely management in the emergency department that will translate into lower sepsis mortality rates(Ramar & Gajic, 2013). To evaluate the effectiveness of the sepsis screening tool and protocol, the following outcomes will be measured:
- SCREENING TOOL PATIENTS WITH A SEPSIS ALERT
- Delay to sepsis protocol implementation
- Concordance with sepsis protocol interventions
- Average Length of stay of septic patients
- Patient mortality in sepsis
Statistical process control charts will be used to assess the data that will be obtained from the electronic health record (EHR) system of the department to monitor trends and identify areas that might need improvement(Robinson, 2018). We will also collect feedback from frontline workers to evaluate the usefulness of the tool and procedure, as well as the user-friendliness of the technology. If the anticipated results are not attained, the team working on the project will conduct an analysis of the data and consider making any required modifications to the screening tool as well as process.
Handling Challenges:
Regarding the implementation of the above-mentioned quality improvement project, there are some possible issues likely to arise. Such threats are resistance to change by personnel, inadequate resources, and the problem faced in implementing new EHRs. To be able to avoid these problems we will then incorporate frequent communication and interactivity of all the stakeholders through all the stages of the project(Simon et al., 2022). Furthermore, there will be human resource educational and training workshops conducted concerning the possible resistance of the staffs. During these sessions participants will ensure an understanding of elements of the screening tool and process, particularly how the designed tool should be used. Besides, the team that will be involved in the project will work closely with the IT support personnel in order to ensure that the tool will fit within the electronic health record systems perfectly(Uffen et al., 2021). That is, in the case where there can be constraints of the available resource, the team will consult the leadership of the department in order to see possible known solutions as well as allocate the resources needed.
Conclusion:
Therefore, this quality improvement project seeks to enhance sepsis identification as well as early management in the emergency department deploying a screening tool and management protocol. This practice-based project has important implications for emergency nursing specifically because its outcomes might lower mortality linked with sepsis, decrease the length of stay, and positively affect patient conditions. Stakeholder participation and commitment will play a big role in the success of the project while cyclic implementation and evaluation will be done through the PDSA cycle.