Sepsis program requires cooperation of departments
An ED manager must work closely with several other departments to ensure the success of a sepsis treatment program, says Tom Sweeney, MD, FACEP, vice chair of emergency medicine at Christiana Care Health Services of Wilmington, DE. Christiana just received the prestigious Ernest Amory Codman Award from The Joint Commission for its Sepsis Alert program.
"It's critical to interface with the pharmacy so you get all the antibiotics you need pre-stocked in the ED, and it's critical to interface with the lab so that any lactate over 4 [mm] now is considered a critical value," he says.
In addition, notes Sweeney, the medical ICU team and intensivists became critical partners. "These resuscitations and work-ups take a lot of ED resources, and patients continue to come into the ED while you're resuscitating them," he explains. "The ED docs need be able to pass the ball relatively quickly to the intensivists."
In most cases, he notes, the ED physician will identify the sepsis patient, perform fluid resuscitation, administer antibiotics, start the central line, and perhaps do the first central venous pressure (CVP). "But someone has to come down to repeat the CVP measurement and get venous oxygen saturation once the CVP is high enough, provide further therapy and, if possible, move the patient up to the ICU," says Sweeney.
Another part of a successful program is providing ongoing reminders to your staff about the importance of the program, he says. "An individual provider will not see a large number of sepsis patients in a given month, so you need to have reminders at least every three months in the form of e-mails, case discussions, or new posters to make people think about the protocol," he advises. "We also suggest an easily available order set that will trigger people to think about the different parts of the protocol."
Another important strategy the ED uses is notification. The intensivist and ICU resident are paged where there is a sepsis alert. Also, an overhead announcement is made.
"This way, people such as the charge nurse are notified quickly, so if one nurse has a sepsis patient, they can quickly get the necessary resources to that nurse," says Sweeney.
An ED manager must work closely with several other departments to ensure the success of a sepsis treatment program, says Tom Sweeney, MD, FACEP, vice chair of emergency medicine at Christiana Care Health Services of Wilmington, DE.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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