Reducing sepsis-related unplanned 30-day readmissions at a hospital-based skilled nursing facility

Abstract

Background: Sepsis is a common and costly medical emergency, often leading to unplanned readmissions. The purpose of this quality improvement project is to integrate staff education, every 4 hours vital signs monitoring guided by sepsis screening score, and structured response via a process map to reduce unplanned 30-day readmission rate by 25% from baseline at a hospital-based skilled nursing facility (HBSNF).

Methods: This project was conducted at an 18-bed HBSNF. Prior to implementing this project, all registered nurses and patient care assistants received education on sepsis. Registered nurses were also trained in the proper use of Nursing Sepsis Management Order Set and How to Respond: A Patient with Suspected Sepsis Process Map. From September 1 to November 30, 2020, the project gradually increased vital signs monitoring frequency from every 12 hours to every 4 hours based on patients’ sepsis risk stratified by sepsis screening score in 3 phases. Systemic Inflammatory Response Syndrome criteria was used to identify sepsis-related unplanned readmissions.

Results: Overall, the 3-month vital signs monitoring compliance rate was 96% (5019/5223). The sepsis-related unplanned 30-day readmission rate was reduced from baseline 47% (17/36) to 21% (4/19) at the end of this project, about a 55% decrease from baseline.

Conclusions: The combination of an evidence-based electronic surveillance system and change in management strategies significantly reduced sepsis-related unplanned 30-day readmissions at this HBSNF. Dissemination of these innovations could improve sepsis management in other HBSNFs and positively impact patients’ health outcomes and healthcare costs.