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Quality assurance in severe sepsis: an individualised audit/feedback system results in substantial improvements at a UK teaching hospital

Introduction

Following our study of severe sepsis care across three centres [1], we aimed to introduce a rapid feedback mechanism into our rolling audit programme. Whilst previous audits raised awareness of severe sepsis, only whole organisation performance was reported and no feedback was given to individual clinicians. It is recognised that such feedback loops can improve clinical practice [2].

Methods

Patients admitted to critical care (58 beds, four units) with a primary admission diagnosis of infection were screened for severe sepsis. Pre-ICU care was then audited against the Surviving Sepsis Guidelines [3]. Time zero is defined as when criteria for severe sepsis were first met. An individualised traffic-light report was then generated and emailed to the patient's consultant and other stakeholders involved in care (Figure 1). We aimed to report cases within 7 days of critical care admission. A cumulative report is generated monthly to track organisation-wide performance.

Figure 1
figure1

Example report.

Results

Since November 2011, 153 cases of severe sepsis have been audited and reported back to clinicians. Compliance with antibiotics in <1 hour has risen from 35 to 75% and compliance with the pre-ICU elements of the resuscitation bundle has risen from 20 to 70% (Figure 2). Feedback from clinicians has been encouraging as our reports highlight both positive and negative examples of practice.

Figure 2
figure2

Compliance with pre-ICU resuscitation bundle.

Conclusion

Individualised feedback on sepsis care has led to substantial improvements in guideline compliance. This concept could be translated to other time-dependent patient pathways.

References

  1. 1.

    Simmonds MJR, Chikhani M, Smith P, et al.: Multi-departmental system analysis is needed for evaluation of severe sepsis care: a multi-centre study [abstract]. In Presented at the BMJ International Forum on Quality and Safety in Healthcare. Amsterdam; 2011.

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    Jamtvedt G, Young JM, Kristoffersen DT, et al.: Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2006, 2: CD000259.

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    Dellinger RP, Levy MM, Carlet JM, et al.: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008, 36: 296-327. 10.1097/01.CCM.0000298158.12101.41

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Correspondence to M Simmonds.

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Simmonds, M., Blyth, E., Robson, W. et al. Quality assurance in severe sepsis: an individualised audit/feedback system results in substantial improvements at a UK teaching hospital. Crit Care 17, P500 (2013). https://doi.org/10.1186/cc12438

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Keywords

  • Severe Sepsis
  • Critical Care
  • Individualise Feedback
  • Patient Pathway
  • Guideline Compliance