Cleveland Clinic implements 'code sepsis' protocol to rapidly assess, treat patients

Throughout Cleveland Clinic's healthcare system, a protocol known as "code sepsis" allows physicians to diagnose and treat the infection before it becomes life threatening. The hospital's standardized sepsis response is carried out by by specialized response teams at the bedside. 

"Code sepsis protocols have helped us improve the consistency and quality of care for patients with sepsis, leading to better outcomes," James Morrison, MD, co-chair of the Enterprise Sepsis Steering Committee and ESI associate quality improvement officer for sepsis at Cleveland Clinic, told Becker's. "Given this success, it was essential to ensure we could provide this important tool across the organization."

When a nurse or other caregiver suspects sepsis after noting a change in a patient's vitals, such as a heart rate above 90, respiratory rate above 20, white blood cell count above 12 or below 4, and a temperature above 101.6 degrees or below 96.8 degrees, a code sepsis is called. 

The sepsis team then steps in to assess and care for the patient. If necessary, the patient is transferred to the appropriate department for treatment.

The standardized sepsis programs are in place at 16 hospitals and, as Cleveland Clinic grows, so will the program, Dr. Morrison added. 

Further, the education surrounding code sepsis encourages teamwork and empowers all providers to recognize the signs of sepsis and initiate lifesaving care, he said.  

Becker's discussed the efficacy of the early sepsis detection initiative at Cleveland Clinic with Dr. Morrison and Allie Tallman, BSN, RN, program manager of SERT.

Question: What is the main benefit of having a Sepsis Emergency Response Team at the ready?

Dr. James Morrison: While sepsis may be relatively common, it affects a very diverse set of patients, and we have learned that we need to be ready to detect and treat sepsis in many different settings.  

While the name varies by location (sepsis alert in the emergency department and code sepsis for inpatients), the strategy is the same. Code sepsis brings resources to the bedside to rapidly assess the patient and start treatment. By having a defined team, sepsis cases can be identified and treated more efficiently using standardized protocols. This helps to ensure that all patients receive the same level of care regardless of the clinical site. 

The timely action of code sepsis teams can improve patient outcomes and save lives. Further, the education surrounding code sepsis encourages teamwork and empowers all providers to recognize the signs of sepsis and initiate lifesaving care.  

Q: How is this particular sepsis program different from other diagnostic and treatment protocols?

Allie Tallman: While most sepsis cases (~80 percent) develop in the community and are present on arrival, the mortality rate for sepsis that develops while a patient is admitted, or is not present on arrival, is notably higher. One of the keys to sepsis treatment and survival lies in recognition and timely intervention/antibiotics. 

At Cleveland Clinic's main campus, a Sepsis Emergency Response Team was developed to help identify patients who show signs of sepsis sooner and facilitate treatment. It consists of APPs from intensive care units who are alerted to potential sepsis patients via an electronic health record best practice alert.

SERT members have the capability to complete bedside labs, like a blood gas and lactate; draw blood cultures; and order antibiotics. SERT is versed in the protocols around sepsis care, including our order set, care path and timing metrics, and have actively educated and encouraged their usage. 

Q: How are you determining if the code sepsis program is saving lives at Cleveland Clinics' campuses?

AT: Not only has SERT improved patient outcomes, but it has also increased the discussion around sepsis care across healthcare teams at main campus. A nurse was incorporated in the SERT team to help improve antibiotic administration, but also round and educate other nurses about the nursing role in sepsis care. Recently, caregivers from phlebotomy have joined SERT at the bedside to obtain lab work and blood cultures. 

JM: Providers in the Emergency Services Institute activated over 3,000 sepsis alerts at 12 different sites last year. Sepsis alerts empower the team and activate pathways that lead to better patient care. When sepsis alerts are called, antibiotics are given earlier, which is an essential intervention in sepsis care. Observed mortality is lower when cCode sepsis is in place. 

Our efforts, including code sepsis, are having an impact, and sepsis mortality decreased at Cleveland Clinic last year. Comparing our performance to prior years, it is estimated that 500 additional lives were saved last year.  

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