Table 1.

Synopsis of Screening and Response Protocols, Sepsis Early Recognition and Response Initiative (SERRI)

Screening for Systemic Inflammatory Response Syndrome (SIRS) (First Response)
First responder personnel	Bedside nurses (acute care hospitals); bedside nurses or patient care assistants (postacute care sites)
Timing	Every 12 hours from the time of admission; clock-time for screening decided on by unit nurses
Elements	Heart rate, temperature, respiratory rate, latest white blood cell (WBC) count, presence of altered mental status. Deviations from normal range are awarded points and a total score is computed; for acute care hospitals only, a total score of ≥ 4 is interpreted as positive for SIRS and initiates contact of the second responder.*
Evidence or guidelines for elements	Elements derived from clinical syndrome described as SIRS; modified in prior testing at the SERRI convener facility; approach to scoring based on that used in the Acute Physiology and Chronic Health Evaluation (APACHE) severity of illness rating system1
Actions	None if score < 4; if score ≥ 4, second responder is contacted immediately.
Other	Screening tool is integrated into the electronic health record of most SERRI partners; a few partners use a Web-based or paper format.
Responding to a Patient with a Positive Screen (Second Response)
Second responder personnel	Nurse practitioners (some acute care hospitals); charge nurses or rapid response teams
Timing	Within one hour of detection of positive screen
Elements	Physical examination and search for source of infection; laboratory work, including cultures and sensitivities; fluid resuscitation; antibiotics; nursing interventions
Evidence or guidelines for elements	Based on the 2008 and subsequent recommendations for goal-directed therapies from the Surviving Sepsis Campaign; 20082 and 20123 International Guidelines for Management of Severe Sepsis and Septic Shock; and recommendations of an expert panel of acute care surgeons at the SERRI convener facility (Houston Methodist Hospital)
Actions	Decision about need for transfer to ICU; notification of attending physician; evaluation for possible infection; early goal-directed interventions (collection of blood and fluids for culture before start of antibiotics; stat fluid resuscitation; administer antibiotics within 1 hour); reassessment after interventions
Other	Nurse practitioners (NPs) in Texas can be credentialed as independent practitioners; at the convener facility and some other SERRI acute care sites, the NPs, using second response/sepsis evaluation and treatment protocols approved by the hospital medical staff, can institute these protocols without waiting for the approval of the attending physician.

^*For the skilled nursing facility/long term acute care hospitals, the positive screen threshold was lowered to ≥ 3 shortly after the initiative’s introduction because most patients in those sites would not have had a WBC count measured in the previous 24 hours.

References

¹Knaus WA, et al. APACHE II: A severity of disease classification system. Crit Care Med. 1985;13:818–829.

²RP, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36: 296–327. Erratum in Crit Care Med. 2008;36:1394–1396.

³Dellinger RP, et al.; Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228.