Hospitals in pursuit of excellence

Better Best Practices

Even best practices need fine-tuning. When the critical care team at Piedmont Hospital, Atlanta, started using IHI's sepsis bundles, they discovered that a deficit in staff's sepsis knowledge, coupled with the bundle requirements created an overwhelming barrier to change. They stepped back and asked, "What can we do to get the most improvement?" With guidance from its process improvement team and an external expert, Piedmont focused on sepsis prevention in the ED. Using a point-based, simple algorithm based on certain criteria and infection-exposure risk, staff identified patients at highest risk. The algorithm was linked to a simple protocol for managing fluids and antibiotics during the first hour treating these patients. Piedmont also initiated an intensive education program for all providers. The result was a huge decrease in mortality. And staff began sharing their stories. Piedmont has spread the protocol to inpatient units. If a patient is identified as a possible sepsis case, a nurse immediately starts the sepsis protocol, which is now embedded in practice.