The Surviving Sepsis Campaign (SSC) partnered with the Institute for Healthcare Improvement (IHI) to incorporate its “bundle concept” into the diagnosis and treatment of patients with severe sepsis and septic shock. We believe that improvement in the delivery of care should be measured one patient at a time through a series of incremental steps that will eventually lead to systemic change within institutions and larger health care systems.
Local SSC implementation is the key to mortality reduction for severe sepsis and septic shock patients. Successful SSC adoption requires a hospital champion who can coordinate the LEADER steps outlined below.
Complete Implementation and Improvement Guide
- Learn about sepsis and quality improvement by attending local and national sepsis meetings.
- Establish a baseline in order to convince others that improvement is necessary and to make your measurements relevant. This should be done prior to formal improvement efforts. Start by collecting data on all severe sepsis patients in your intensive care unit (ICU) - you may see only one or two patients per day.
- Ask for buy-in from institutional leadership and seek initial support from the emergency department (ED) and ICU staff and directors, quality improvement personnel, nursing staff, and others. You may want to watch the webcast “Administrative Buy-In: Key to Sepsis Care Improvement
Form a sepsis team and bring all stakeholders to the table for input. Tell people what you are doing and why. You may not receive initial support across the board, but opinions often change when data start to become available.
Publicize the SSC with a formal kick-off event.
Highlight several physicians to speak about the effort and invite representatives from administration, medicine, nursing, respiratory therapy, and pharmacology. This commitment will provide early momentum and drive improvement efforts forward.
- Develop an institution-specific SSC protocol comprising all bundle elements.
Seek feedback and refine your protocol to the satisfaction of your team. Assign a “protocol owner” with the task of refining the protocol and patiently obtaining feedback from all stakeholders.
Invite comments and suggestions at regular team meetings. Publish refinements by scheduled deadlines and label each version with a date to ensure uniformity of use.
- Educate stakeholders in the ED and ICU and floors according to shift schedules. Post the SSC protocol in several prominent locations.
Familiarize staff with the bundles and your protocol. Explain the importance of the bundle tools. Tolerate failure and revise teaching as needed.
- Remediate errors and anticipate obstacles along the way.
Recount successes and failures every month. The SSC database can create graphs that benchmark your success and demonstrate powerful visuals of clinical targets where improvement is important. Everybody involved needs to see what is happening to drive the SSC effort forward. Identify critical failure modes as a team and redesign processes as needed while simultaneously measuring your results.