Table 1 Key results of the KPNC sepsis mortality reduction initiative (aggregate data for all 21 hospitals)
From: Kaiser Permanente Northern California sepsis mortality reduction initiative
Measure | Baseline | Rapid adoption (December 2010)a | Sustainability (May 2012)a |
|---|---|---|---|
Sepsis diagnoses per 1,000 admits | 35.7 (2006 to early 2008) | 98.3 | 137.9 |
Admitted patients with blood cultures in ED have lactate test in ED | 27% (early 2008) | 96.5% | 95.6% |
ABX w/in 60 minutes of dx of shock | 69.5% (Q3 2009) | 90.4% | 91.8% |
CL w/in 2 hours of dx (first CVP of ScvO2 in 2 hours) | 41.5% (Q3 2009) | 78.6% | 89.6% |
Mean BP (MAP) at target | 52% (Q3 2009) | 90.4% | 93.8% |
CVP at target | 41.5% (Q3 2009) | 83.8% | 92.8% |
ScvO2 at target | 30.8% (Q3 2009) | 74.3% | 81.4% |
Lactate lower within 6 hours for EGDT | 52% (Q3 2009) | 91.2% | 95.9% |
EGDT bundle | 7.3% (Q3 2009) | 55.1% | 70.1% |
Sepsis raw mortality | 24.6% (2006 to early 2008) | 11.5% | 8.7% |
Sepsis observed/expected (O/E) mortality | 1.07 (rolling year ending Q1 2008) | 0.82 | 0.56 |
Sepsis O/E LOS | 1.07 (rolling year ending Q1 2008) | 0.89 | 0.75 |
EGDT population mortality (only patients with refractory shock or lactate ≥4) | 29.7% (239 cases, July to August 2009) | 20.2% (391 cases, Q4 2010) | 18.6% (323 cases, March-May 2012) |
Raw all cause adult non-OB KPNC hospital mortality | 3.63% (2006 to 2007) | 3.11% (2010) | 3.07% (year ending Q2 2012) |
HSMR-Medicate only | 0.92 (rolling year ending Q2 2008) | 0.60 (YE 2010) | 0.52 (YE 2011) |
Balancing measures: EGDT associated harm | July to December 2009 | July to December 2010 | December 2011 to May 2012 |
   BSI | 0 | 0 | 0 |
   Retained guidewires | 3 | 0 | 0 |
   Pneumothorax | 1 | 2 | 4 |