STREAMLINING SEPSIS CARE IN THE EMERGENCY DEPARTMENT OF A TERTIARY CARE CENTRE IN NORTHERN INDIA-A QUALITY IMPROVEMENT PROJECT
Introduction: Strict adherence to the sepsis bundle especially the early identification, collection of adequate cultures and administration of appropriate antibiotic plays a key role in patient outcome in the Emergency Department(ED). Aim: The study was a Quality Improvement (QI) project and the primary objectives were to identify the door to antibiotic time (DTAT) for patients with suspected sepsis and streamlining it to one hour bundle as per surviving sepsis campaign guidelines and to increase the blood culture collection rate by atleast 25-30% in one year. The secondary objective was to identify the factors affecting the blood culture collection in emergency. Methods: This study was a prospective observational QI project which was conducted in the ED of a tertiary care centre in Northern India, with an average daily intake of 70-80 patients. It was conducted from September 2021 to August 2022. All adult patients presented to the emergency with suspected sepsis were included, except patients of trauma and cardiac arrest. Data was collected in the pre-intervention phase and subsequently Plan-Do-Study-Act cycles were conducted to improve the deficient parameters. Further they were implemented and assessed in the intervention and post-intervention phases. Results: Though it was observed that the antibiotic was administered as per the bundle and there was no significant delay, the culture collection rates were very low. It was almost nil in the pre-intervention phase which improved tremendously to 94% in the post-intervention phase. Introduction of newer protocols, on-site training and awareness and frequent reassessments proved to be a major factor in the improvement of the rates. Conclusion: This QI study helped us in identifying a major lacuna in sepsis care in ED. Phase-wise assessments, on-site trainings and frequent reassessments helped us in achieving a target well above the set one.