Identifying and Assessing Barriers to Meeting Sepsis Guidelines in the Emergency Department at an Urban Academic Medical Center: A Process Analysis
Problem: Globally, sepsis is a major public health problem with 48.9 million cases worldwide in 2017; the United States experiences 1.7 million cases annually that significantly contribute to patient morbidity and mortality. Timely recognition and management of sepsis, especially in the emergency department (ED), improves morbidity and mortality outcomes. Currently, EDs face difficulty in meeting the time sensitive benchmarks set forth by the Centers for Medicare and Medicaid Services (CMS) to diagnose and treat sepsis, which could lead to poor patient outcomes and financial penalties for healthcare institutions.Project Aims: The purpose of this quality improvement project was to understand the barriers to meeting compliance with the CMS Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) at an urban academic medical center (UAMC) ED. The aims of this project were to assess the current protocol in place for sepsis management and identify barriers to meeting the goals of the CMS SEP-1 management bundle in the ED. Project Methods: Donabedian’s model guided this quality improvement project. A one month, retrospective chart review was conducted on adult patients ≥ 18 years who entered an UAMC ED in 2019 with a diagnosis of sepsis, severe sepsis, or septic shock to determine gaps in compliance with the CMS SEP-1 management bundle. This process analysis will aid the UAMC ED in understanding how to overcome barriers to CMS SEP-1 compliance. Results: In December of 2019, 66 charts met inclusion criteria for SEP-1, with 40 charts that failed. The most significant barriers to SEP-1 compliance were inadequate intravenous fluid administration and delayed antibiotic administration, accounting for 25 out of 40 of the fallouts. Future initiatives should aim to improve compliance with these metrics. Keywords: Emergency department, severe sepsis, septic shock, CMS, SEP-1
Nursing, Health education, Health sciences, CMS, Emergency Department, SEP-1, Sepsis, Septic Shock, Severe Sepsis
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