ABSTRACTS
Improving Treatment Times in Sepsis Patients by Utilizing Prehospital Sepsis AlertsAuthor: Todd Costa, MSN, RN, CEN, CPEN | | Associate Authors: Abigail Baur, RN, CEN, Jodee Lenjnieks, MSN, RN, David Yoon, BS, Brandon Grinstead, BS, EMT-P, Anjan Purohit, MBA, EMT-P, Claus Hecht, MD, FACEP
Introduction Sepsis is a life-threating response to infection. Approximately 350,000 adults die annually in the United States from sepsis. It is estimated that every hour of delayed treatment increases mortality by 6–8%. Time-sensitive conditions such as stroke, STEMI, and trauma utilize prehospital alerts to improve treatment times. A Continuous Quality Improvement (CQI) project using sepsis screening and hospital alerting was conducted to increase prehospital sepsis identification and decrease treatment delays in the emergency department (ED). Objective To evaluate the effectiveness of sepsis screening and hospital alerting in increasing prehospital sepsis identification and reducing delays in treatment. Methods A fire-based EMS provider agency and a community hospital system jointly developed and implemented this project over a 5-month period (February 2023 through June 2023). A sepsis checklist was created in the prehospital electronic patient care record (PCR). EMS personnel were to make a prehospital sepsis alert for patients who had a positive checklist. Chart abstraction of patients who arrived by EMS and diagnosed with sepsis in the ED was performed to determine treatment times for three categories: (1) positive checklist and prehospital alert, (2) positive checklist without prehospital alert, and (3) no checklist complete nor prehospital alert. Results A total of 125 sepsis patient charts were reviewed: 48 (38%) had positive prehospital checklists and prehospital alerts, 41 (33%) had prehospital checklists without prehospital alerts, and 36 (29%) had no checklist nor alert. Patients with positive prehospital checklists and prehospital alerts had the fastest time to treatment (EMS patient contact to ED antibiotic order) of 55 minutes, compared to those with a positive checklist but no prehospital alert (109 minutes), and those without checklist or prehospital alert (121 minutes). Door-to-antibiotic order time was also measured and demonstrated similar outcomes. Patients with a positive prehospital checklist and prehospital alert had the fastest time to treatment at 28 minutes, compared to 81 minutes for patients with a positive checklist without prehospital report, and 90 minutes for patients without a checklist or prehospital report. Conclusion The use of a sepsis checklist in the PCR to initiate a prehospital notification reduced treatment times for sepsis patients. Hospitals and EMS providers looking to improve treatment times for sepsis patients should consider implementing prehospital sepsis notifications triggered by a sepsis checklist integrated into their PCR.
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