Location
Virtual
Start Date
1-3-2024 8:00 AM
End Date
1-3-2024 3:30 PM
Keywords:
california; phch
Description
Background. Sepsis-related hospitalizations with prolonged length of stay (LOS) are rising in the US. Likewise in our setting, sepsis is the #1 diagnosis-related group (DRG). Moreover, our sepsis patient outcomes for DRG-related LOS, timely discharge, readmission rates, and observed/expected (O/E) mortality did not meet our healthcare system’s regional goals. Thus, because evidence suggests that interprofessional rounds may improve those outcomes among non-sepsis patients, we decided to add afternoon interprofessional rounds to existing morning rounds. Those Sepsis 5 Rights Rounds (S5RR) would focus on the right patient, place, time, level of care, and plan of care.
Purpose.The purpose of this quality improvement (QI) project was to measure whether routine, evidence-based, interprofessional rounds would impact QI-tracked patient outcomes on our inpatient sepsis unit.
Methods. This QI project used continuous LOS, discharge, readmission, and O/E outcome data already collected by the QI Department. Those data were for both DRG 871(Septicemia or severe sepsis without mechanical ventilation >96 hours with major complication and comorbidity) and DRG 872 (Septicemia or severe sepsis without mechanical ventilation >96 hours without major complication and comorbidity). The sample was inclusive of the target population: Persons admitted to our 24-bed sepsis unit in a 377-bed, Magnet-recognized, non-profit medical center. We compared 12 months of pre-intervention LOS, 30-day readmission, time to discharge, and O/E mortality data to 11 months of the same data during S5RR. The intervention S5RR members were the unit case manager, nurse manager, charge nurse, physician champion, and sepsis coordinator, and S5RR roles were specified in writing. Rounds were Monday through Friday, 1400-1430 via TEAMS software using Epic dashboard, and discussion focused on barriers to timely discharge, opportunities, and risks. Unfortunately, the physician did not attend. Pre and post data were analyzed descriptively by tracking changes and comparing them to regional goals.
Results. Tracking charts showed variations during the project with the following mean (M) score changes in parentheses (pre M to post M). All decreasing means met regional goals. LOS for DRG 871 rose (6.06 to 6.43) and fell for DRG 872 (3.82 to 3.69); O/E mortality fell for both DRG 871 (0.69 to 0.51) and DRG 872 (0.85 to 0); 30-day readmission rate fell for DRG 871 (13.89 to 12.71) but rose for DRG 872 (9.09 to 11.36); Time to discharge fell for DRG 871 (5.79 to 5.48) and DRG 872 (5.06 to 4.35). DRG 871 n’s = 78 pre and 144 post; DRG 872 n’s = 21pre and 98 post.
Conclusion. Six of eight outcomes met regional goals even without physician champion participation. Six care improvements lowered costs: LOS (DRG 872), O/E mortality (both DRGs), readmissions (DRG 871), and discharge time (both DRGs). Two indicators of LOS (DRG 871) and readmissions (DRG 872) require further work to meet goals. Anecdotally S5RR transformed decision-making, interprofessional collaboration, communications, and patient safety.
Implications for practice. We continue afternoon S5RR, inviting physician attendance, and QI monitoring to meet goals. Adding similar rounds may help others meet their sepsis-related goals for LOS, O/E mortality, readmissions, and time to discharge.
Recommended Citation
Lim, William; Pellissery, Bilma; and Carrillo, Jenny, "Sepsis 5 Rights Round (S5RR)" (2024). Providence Nursing Research Conference 2023 – Present. 10.
https://digitalcommons.providence.org/prov_rn_conf_annual/2024/posters/10
Specialty
Nursing
Included in
Sepsis 5 Rights Round (S5RR)
Virtual
Background. Sepsis-related hospitalizations with prolonged length of stay (LOS) are rising in the US. Likewise in our setting, sepsis is the #1 diagnosis-related group (DRG). Moreover, our sepsis patient outcomes for DRG-related LOS, timely discharge, readmission rates, and observed/expected (O/E) mortality did not meet our healthcare system’s regional goals. Thus, because evidence suggests that interprofessional rounds may improve those outcomes among non-sepsis patients, we decided to add afternoon interprofessional rounds to existing morning rounds. Those Sepsis 5 Rights Rounds (S5RR) would focus on the right patient, place, time, level of care, and plan of care.
Purpose.The purpose of this quality improvement (QI) project was to measure whether routine, evidence-based, interprofessional rounds would impact QI-tracked patient outcomes on our inpatient sepsis unit.
Methods. This QI project used continuous LOS, discharge, readmission, and O/E outcome data already collected by the QI Department. Those data were for both DRG 871(Septicemia or severe sepsis without mechanical ventilation >96 hours with major complication and comorbidity) and DRG 872 (Septicemia or severe sepsis without mechanical ventilation >96 hours without major complication and comorbidity). The sample was inclusive of the target population: Persons admitted to our 24-bed sepsis unit in a 377-bed, Magnet-recognized, non-profit medical center. We compared 12 months of pre-intervention LOS, 30-day readmission, time to discharge, and O/E mortality data to 11 months of the same data during S5RR. The intervention S5RR members were the unit case manager, nurse manager, charge nurse, physician champion, and sepsis coordinator, and S5RR roles were specified in writing. Rounds were Monday through Friday, 1400-1430 via TEAMS software using Epic dashboard, and discussion focused on barriers to timely discharge, opportunities, and risks. Unfortunately, the physician did not attend. Pre and post data were analyzed descriptively by tracking changes and comparing them to regional goals.
Results. Tracking charts showed variations during the project with the following mean (M) score changes in parentheses (pre M to post M). All decreasing means met regional goals. LOS for DRG 871 rose (6.06 to 6.43) and fell for DRG 872 (3.82 to 3.69); O/E mortality fell for both DRG 871 (0.69 to 0.51) and DRG 872 (0.85 to 0); 30-day readmission rate fell for DRG 871 (13.89 to 12.71) but rose for DRG 872 (9.09 to 11.36); Time to discharge fell for DRG 871 (5.79 to 5.48) and DRG 872 (5.06 to 4.35). DRG 871 n’s = 78 pre and 144 post; DRG 872 n’s = 21pre and 98 post.
Conclusion. Six of eight outcomes met regional goals even without physician champion participation. Six care improvements lowered costs: LOS (DRG 872), O/E mortality (both DRGs), readmissions (DRG 871), and discharge time (both DRGs). Two indicators of LOS (DRG 871) and readmissions (DRG 872) require further work to meet goals. Anecdotally S5RR transformed decision-making, interprofessional collaboration, communications, and patient safety.
Implications for practice. We continue afternoon S5RR, inviting physician attendance, and QI monitoring to meet goals. Adding similar rounds may help others meet their sepsis-related goals for LOS, O/E mortality, readmissions, and time to discharge.
