(1260) Improving Outcomes in Sepsis

Introduction: In April of 2022, sepsis order set utilization for patients was 38.7% in the Surgical Intensive Care Unit (SICU) at Cleveland Clinic main campus despite the enterprise standard being set at 50%. This is problematic because under utilization of the sepsis order set can result in deviations from the standard of care and can cause delays in antibiotic administration. We hypothesized that increasing sepsis order set utilization will result in better patient outcomes and earlier antibiotic administration.

Methods: Our data was calculated by assessing the number of patients discharged with sepsis as a diagnosis who received the sepsis order set during their admission. A survey was sent out to residents, fellows, attending staff, and nurse practitioners to assess why the order set was not utilized regularly. The most common reasons for order set underutilization were identified to be that some orders for sepsis management were already individually placed outside of the order set and that the sepsis diagnosis was unclear. Each root cause identified was met with a countermeasure. These countermeasures began in May of 2022 and they aimed at increasing order set awareness by incorporating the sepsis order set discussion into SICU orientation as well as morning sign out where SICU team members designated patients that the order set should be considered for.

Results: After implementation of our countermeasures and close follow up, sepsis order set utilization increased. Our initial data showed that the order set was only used 38.7% of the time. In the months of November 2022, December 2022, and February 2023 order set utilization was 87.5%, 91.7%, and 100% respectively. This lead to increased antibiotic administration within one hour of order placement, with 74.1% being administered within the hour of order placement. These improvements correlate with a significant reduction in mortality. In May of 2022, sepsis had a mortality rate of 50%. But by May 2023, the sepsis mortality rate decreased to 0%.

Conclusions: Mortality due to sepsis increases by 7.6% with every hour delay in antibiotic administration. Increased awareness and proper usage of the sepsis order set in the ICU has resulted in overall improvements in antibiotic administration within one hour as well as improved mortality rates.