Table 2.
Comparison of Hospital Classification by Three Aggregation Strategies
| Sepsis Program Core Element Assessment Tool question | Method 1 | Method 2 | Method 3 | p |
|---|---|---|---|---|
| Yes, n (%) | Yes, n (%) | Yes, n (%) | ||
| Hospital Leadership Commitment | ||||
| Q1: Sepsis program leaders given sufficient time to manage hospital sepsis program | 10 (52.6%) | 13 (68.4%) | 19 (100%) | 0.01 |
| Q2: Sepsis program given sufficient resources like analytics and IT support to operate effectively | 5 (26.3%) | 10 (52.6%) | 16 (84.2%) | < 0.01 |
| Q3: Staff from key clinical groups/support depts have sufficient time to contribute to sepsis activities | 7 (36.8%) | 11 (57.9%) | 19 (100%) | < 0.01 |
| Q4: Our hospital has senior leader (e.g., CMO, CNO) who serves as Executive Sponsor for sepsis program | 7 (36.8%) | 12 (63.2%) | 19 (100%) | < 0.01 |
| Q5: Sepsis identified as hospital priority by hospital leadership and priority communicated to staff | 11 (57.9%) | 13 (68.4%) | 18 (94.7%) | 0.03 |
| Q6: Hospital leadership communicates to staff and patients how hospital is addressing sepsis | 6 (31.6%) | 8 (42.1%) | 18 (94.7%) | < 0.01 |
| Q7: Hospital leaders have regular meetings with sepsis program leaders to assess resources needed to accomplish goals for sepsis activities and outcomes | 7 (36.8%) | 11 (57.9%) | 19 (100%) | < 0.01 |
| Q8: Hospital sepsis program activities are integrated into other QI and patient safety efforts | 9 (47.4%) | 15 (78.9%) | 19 (100%) | < 0.01 |
| Q9: Hospital staff performance incentives are tied to achievement of targets for sepsis care or outcomes | 3 (15.8%) | 4 (21.1%) | 16 (84.2%) | < 0.01 |
| Q10: Sepsis program-related duties are included in job description or performance reviews for hospital sepsis program leaders and key support staff | 5 (26.3%) | 6 (31.6%) | 17 (89.5%) | < 0.01 |
| Q11: Hospital leadership supports external training/education for sepsis program leaders, key support staff | 10 (52.6%) | 14 (73.7%) | 19 (100%) | 0.01 |
| Q12: Hospital leadership supports internal training and education on sepsis for hospital staff and trainees | 9 (47.4%) | 14 (73.7%) | 19 (100%) | 0.01 |
| Q13: Hospital leadership supports participation in regional, national, and international sepsis QI collaboratives and initiatives | 7 (36.8%) | 13 (68.4%) | 19 (100%) | < 0.01 |
| Accountability | ||||
| Q14: Hospital has program or committee charged with monitoring and improving sepsis care and outcomes | 12 (63.2%) | 13 (68.4%) | 19 (100%) | 0.04 |
| Q15: Hospital has 1–2 leaders (physician, nurse) responsible for sepsis program or committee | 10 (52.6%) | 13 (68.4%) | 19 (100%) | 0.01 |
| Q16: Hospital sets ambitious-but achievable-goals for improving sepsis care and patient outcomes that are informed by review of hospital practices, sepsis outcomes, and clinical guidelines | 11 (57.9%) | 13 (68.4%) | 19 (100%) | 0.02 |
| Q17: Hospital assesses progress towards sepsis goals at regular intervals and updates goals periodically (e.g., annually) to promote continual improvement | 10 (52.6%) | 15 (78.9%) | 19 (100%) | 0.01 |
| Q18: Hospital has 1 physician and 1 nurse lead or champion to ensure physician and nursing engagement | 8 (42.1%) | 12 (63.2%) | 19 (100%) | < 0.01 |
| Q19: Sepsis program activities and outcomes included in annual performance reviews for program leaders | 4 (21.1%) | 6 (31.6%) | 18 (94.7%) | < 0.01 |
| Q20: Hospital has unit-level physician and nurse champions for sepsis activities | 2 (15.8%) | 3 (15.8%) | 18 (94.7%) | < 0.01 |
| Q21: Sepsis program activities and outcomes reported to senior hospital leadership or board of directors | 12 (63.2%) | 14 (73.7%) | 19 (100%) | 0.05 |
| Multi-Professional Expertise | ||||
| Q22: Hospital has sepsis coordinator, who oversees day-to-day implementation of sepsis program activities | 7 (36.8%) | 8 (42.1%) | 19 (100%) | < 0.01 |
| Q23: Clinicians and leaders from ED, IP wards, and ICUs are fully engaged in sepsis program activities | 7 (36.8%) | 11 (57.9%) | 19 (100%) | < 0.01 |
| Q24: Hospital sepsis program includes diverse multi-disciplinary representation | 5 (26.3%) | 8 (42.1%) | 18 (94.7%) | < 0.01 |
| Q25: Hospital sepsis program has ongoing support from individuals with expertise and formal training in data management and analytics, IT, and QI and patient safety | 7 (36.8%) | 12 (63.2%) | 19 (100%) | < 0.01 |
| Q26: Hospital sepsis program has at least ad hoc involvement of case management, microbiology, lab medicine, phlebotomy, outpatient clinicians, hospital epidemiology, infection prevention, patients, families | 4 (21.1%) | 8 (42.1%) | 18 (94.7%) | < 0.01 |
| Action | ||||
| Q27: Hospital implemented standard process to screen for sepsis on presentation, through hospitalization | 8 (42.1%) | 13 (68.4%) | 19 (100%) | < 0.01 |
| Q28: Hospital has hospital guideline or standardized care pathway for management of sepsis | 10 (52.6%) | 14 (73.7%) | 19 (100%) | < 0.01 |
| Q29: Hospital has order sets for management of sepsis tailored to patient populations served | 11 (57.9%) | 16 (84.2%) | 19 (100%) | 0.01 |
| Q30: Hospital has structures and processes in place to facilitate prompt delivery of antimicrobials | 14 (73.7%) | 17 (89.5%) | 19 (100%) | 0.14 |
| Q31: Hospital has structures and processes in place to support effective hand-offs of patients with sepsis | 4 (21.1%) | 9 (47.4%) | 19 (100%) | < 0.01 |
| Q32: Hospital rapid response team is trained in sepsis recognition and care | 9 (47.4%) | 12 (63.2%) | 19 (100%) | < 0.01 |
| Q33: Hospital has ‘code sepsis’ protocol for facilitating prompt recognition and team-based care of sepsis | 8 (42.1%) | 13 (68.4%) | 18 (94.7%) | < 0.01 |
| Q34: Hospital completes peri-discharge evaluations of patients after sepsis to screen for new or worsening limitations, cognitive impairment, posttraumatic stress disorder/anxiety symptoms, and chronic conditions | 5 (26.3%) | 7 (36.8%) | 16 (84.2%) | < 0.01 |
| Q35: Hospital has post-discharge care coordination and anticipatory guidance to optimize sepsis recovery | 5 (26.3%) | 9 (47.4%) | 18 (94.7%) | < 0.01 |
| Q36: Hospital has prevention of HAI, HO sepsis that follow facility infection prevention recommendations | 15 (79.0%) | 18 (94.7%) | 19 (100%) | 0.17 |
| Tracking | ||||
| Q37: Hospital monitors hospital sepsis epidemiology, such as number of hospitalizations | 8 (42.1%) | 13 (68.4%) | 19 (100%) | < 0.01 |
| Q38: Hospital monitors hospital sepsis management, such as time to antibiotic delivery | 16 (84.2%) | 19 (100%) | 19 (100%) | 0.38 |
| Q39: Hospital monitors sepsis outcomes, such as in-hospital mortality and length of hospitalization | 13 (68.4%) | 17 (89.5%) | 19 (100%) | 0.06 |
| Q40: Hospital assesses use, usability, and impact of sepsis tools to inform their ongoing improvement | 10 (52.6%) | 14 (73.7%) | 19 (100%) | < 0.01 |
| Q41: Hospital monitors progress towards achieving hospital goals for sepsis management and/or outcomes | 15 (79.0%) | 17 (89.5%) | 19 (100%) | 0.30 |
| Q42: Hospital completes near real-time chart reviews for the purpose of clinician feedback and education | 8 (42.1%) | 10 (52.6%) | 19 (100%) | < 0.01 |
| Q43: Hospital completes chart reviews regularly for root cause analysis and process improvement | 13 (68.4%) | 15 (78.9%) | 19 (100%) | 0.10 |
| Reporting | ||||
| Q44: Hospital reports sepsis treatment/outcome data to nursing, physician, unit-based, hospital leadership | 8 (42.1%) | 13 (68.4%) | 19 (100%) | < 0.01 |
| Q45: Hospital provides feedback to individual clinicians regarding the care of recent patients with sepsis | 7 (36.8%) | 10 (52.6%) | 19 (100%) | < 0.01 |
| Q46: Hospital has and maintains a live dashboard to report sepsis treatment and outcomes in real-time | 1 (5.3%) | 1 (5.3%) | 14 (73.7%) | < 0.01 |
| Education | ||||
| Q47: Hospital provides sepsis specific training and education in the hiring or on-boarding process | 7 (36.8%) | 12 (63.2%) | 19 (100%) | < 0.01 |
| Q48: Hospital provides annual sepsis education to clinical staff | 6 (31.6%) | 10 (52.6%) | 19 (100%) | < 0.01 |
| Q49: Hospital provides written and verbal sepsis education to patients, families/caregivers before discharge | 6 (31.6%) | 11 (57.9%) | 19 (100%) | < 0.01 |
| Q50: Hospital posts information on recognition of sepsis in prominent areas for patient-facing staff | 7 (36.8%) | 8 (42.1%) | 18 (94.7%) | < 0.01 |
| Q51: Hospital holds lectures (e.g., grand rounds) or an annual meeting focused on sepsis | 3 (15.9%) | 3 (15.9%) | 16 (84.2%) | < 0.01 |
| Q52: Hospital includes sepsis recognition and treatment in annual nursing competencies | 5 (26.3%) | 10 (52.6%) | 18 (94.7%) | < 0.01 |
Abbreviations: IT, information technology; CMO, Chief Medical Officer; CNO, Chief Nursing Officer; QI, quality improvement; ED, emergency department; IP, inpatient; ICU, intensive care unit; HAI, healthcare-associated infection; HO, hospital-onset
Method 1: All responses=Yes; Method 2: ≥ 0.70 responses=Yes; Method 3: Any responses=Yes