In this episode, I’ll discuss the effect of a sepsis huddle on identifying sepsis and compliance with the sepsis bundle in an Emergency Department setting.
The Sepsis huddle has been described as a method of improving sepsis bundle compliance. The concept is that a group of clinicians convene (often at the patient’s bedside) to discuss a patient’s need for items in the sepsis bundle and this leads to improved bundle compliance.
One group of researchers in Sweden took this concept one step further and examined the effects of a sepsis huddle not just on sepsis bundle compliance but also sepsis identification. They published a retrospective single-center cohort study looking at the impact of a multidisciplinary sepsis huddle in the emergency department. Shout out to “Pharmacy Hend” who is a podcast listener, Hospital Pharmacy Academy member, and one of the authors on this article.
The huddle process worked like this:
1. When the huddle was activated a page was sent via Vocera to all ED staff.
2. The provider, primary nurse, ED pharmacist, and ED charge nurse met at the patient’s bedside for evaluation and activation of code sepsis if indicated.
3. If an ED pharmacist was not available and a code sepsis was activated, the inpatient hospital pharmacist would receive a page so they could prioritize order verification and expedite the delivery of antibiotics.
After implementing the huddle process the authors compared 80 post-huddle patients with 21 pre-huddle patients. The pre-huddle period provided notification of possible sepsis to providers within the electronic medical record using an alert system.
It was the ED triage nurse that activated the huddle most often based on the patient’s chief complaint and initial vital signs.
Between the two groups, code sepsis was activated 91.3% of the time when the huddle was used compared to only 9.5% of the time when only the EHR alert was used. This represents a tremendous increase in the number of patients identified with sepsis based on the huddle process.
Other measures of sepsis care also increased tremendously in the huddle group including:
- Sepsis bundle compliance which improved from 24% to 80%
- Antibiotics within one hour which improved from 33% to 90%
- Culture within one hour which improved from 67% to 95%
- Order entry under 30 min. which improved from 29% to 86%
- Median order entry time which improved from 48 to 3 min
All of these improvements reached statistical significance.
When individual factors were analyzed for their contribution to the results, the best predictor of bundle compliance was actually physician order entry under 30 min.
Before the huddle, almost half of the physician order entry times were over an hour to begin with, guaranteeing non-compliance. However after the huddle only 5% of the order entry times exceeded 1 hour.
While the study was a retrospective and single-center study which is not always generalizable, it should be fairly simple to check your institution’s physician order entry time on sepsis patients. A high percentage of patients with a physician order entry time over 30 minutes might signal that an ED sepsis huddle process could offer substantial improvements to bundle compliance rates and sepsis recognition.
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If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
We do something similar albeit more tailored to our work env in our facility but ed pharmacist carries a sepsis pager that goes off ONLY for + LA with significantly hypotension. We try to make the pager only go off in cases of severe sepsis to abide by the data (severe sepsis = early abx made significant diff) and to prevent pager fatigue/maximize efficiency in a busy env. That I think is the key to our success….
(To all you millennials: a pager is…ahh just google it.)
Anyways I know our abx times have improved in doing so as once we get the page, d/w ed md and if + we enter abx orders (typically per pharm), then if rn is busy we will grab the abx, prime the line, + hang it so that rn just needs to start it. I am sure many other ed pharmacists do the same around the country though…right?