Accelerating Detection and Intervention for Sepsis in Skilled Nursing Facilities Using a Sepsis Pathway

Abstract

Background: Early detection of sepsis decreases mortality in hospitals, but recognition of sepsis is often delayed in skilled nursing facilities (SNFs). Local Problem: A local SNF in the northeastern United States sought to use a standardized sepsis pathway to prevent hospital readmissions due to sepsis. Methods: A pre-/postimplementation design was used for this project. Outcome measures included sepsis detection and treatment, length of stay in the SNF, sepsis-related hospital transfer rate, mortality rate, and predictors of clinical outcomes. Interventions: A SNF sepsis pathway was developed based on current sepsis detection tools. The pathway incorporated a sepsis screening tool and a sepsis bundle. Implementation of the pathway involved education of nurses and certified nursing assistants on the pathway. Results: A total of 178 patients were included in data analysis (81 preimplementation and 97 implementation). Sepsis recognition increased from 56% to 86% (P < .001), and sepsis-related hospital transfers decreased from 68% to 44% (P = .07). Laboratory testing for lactate, white blood cell count, and blood cultures increased, and sepsis intervention rates significantly improved (P < .001). Conclusions: Implementing a modified SNF sepsis pathway accelerated identification of sepsis and improved clinical outcomes.