The development and implementation of a nurse practitioner sepsis screening team: Impact on transfer mortality

Abstract

Background: Sepsis is a potentially deadly but treatable condition that occurs as a result of the systemic manifestations of infection. Despite large healthcare expenditures, patient outcomes can be poor, and survivors may still suffer from permanent organ damage, cognitive impairment, and physical disability. Failure to recognize and implement early goal-directed therapy leads to increased mortality. A review of hospital mortality identified that sepsis among inbound transfer patients to acute care units significantly contributed to the overall hospital mortality. As part of a multipronged, multidisciplinary approach, a nurse practitioner sepsis screening team was implemented to improve early diagnosis and treatment of sepsis and decrease mortality in this high-risk population.

Methods: A large academic medical facility located in the Texas Medical Center in Houston accepts a significant number of transfer patients requiring a higher level of care from other institutions. A nurse practitioner sepsis screening team was created to focus on this highly vulnerable group. A validated, electronic screening tool was utilized to screen patients and facilitate early identification and treatment of sepsis. The nurse practitioner team screened and evaluated 3,268 inbound transfer patients from 10/01/2009 to 06/30/2012. When a high suspicion for sepsis was appreciated, or another acute condition was identified, the nurse practitioner collaborated with the attending physician and initiated appropriate treatment. The data analyzed were part of an Institutional Review Board (IRB) approved prospectively collected data set. The data were collected over a 57 month period spanning from 09/30/2007 through 06/30/2012 on all inbound transfer patients to the facility, which include pre-screening baseline statistics. Basic demographics including the patient’s age, gender, and race were collected. The outcome variable was status at discharge from the facility (alive or dead). After verifying assumptions of the chi-square test were met, a Pearson’s chi-square was run against the data set. All data were analyzed using IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.

Results: There was a significant association between inbound transfer patients who were evaluated upon arrival at this institution by the nurse practitioner sepsis screening team and mortality in this population regardless of their diagnoses (χ² (1) 115.04, p < .001). A patient not screened by the team was more likely to die during the hospitalization than a transfer patient that was screened.

Conclusion: In this institution, the development and implementation of a nurse practitioner sepsis screening team has contributed to reducing mortality among the inbound acute care patient transfer population regardless of diagnoses. Further investigation is needed to understand the exact mechanisms that have contributed to this outcome.