HOW TO IMPROVE
Three core strategies will guide your improvement in implementing the evidence-based guidelines for the management of septic patients, outlined by the Surviving Sepsis Campaign:
The Model for Improvement
The Model for Improvement is a simple yet powerful tool for accelerating improvement. This model has been used by hundreds of health care organizations in many countries to improve many different health care processes, resulting in improved outcomes. Using the key elements of the model, especially testing changes on a small scale with Plan-Do-Study-Act (PDSA) cycles, has helped organizations improve care.
Bundles
Using "bundles" simplifies the complex processes of the care of patients with severe sepsis. A bundle is a selected set of elements of care distilled from evidence-based practice guidelines that, when implemented as a group, have an effect on outcomes beyond implementing the individual elements alone. Each hospital's sepsis protocol may be customized, but it must meet the standards created by the bundle.
Reliability
Enhancing reliability of these bundle elements allows teams to focus on aspects of the changes they are implementing to create a reliable system that achieves the goal of 25 percent reduction in mortality due to sepsis called for by the Surviving Sepsis Campaign. The change concepts for improving care of severely septic patients come from the published guidelines of the Surviving Sepsis Campaign [Dellinger RP, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock.
Improvement efforts should be led by a multidisciplinary core team. Forming the Team:
Setting Aims
Commitment to improving critical care delivery is reflected by a strong and well- worded aim statement.
Establishing Measures
Measures should provide information-for example, did the
introduction of the ventilator bundle decrease length of time on the ventilator?
Selecting Changes
Teams must test and implement changes at four levels: patient, care team,
leadership and system, and flow in and out of the ICU in order to improve critical
care delivery.
Testing Changes
The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change in the real
work setting — by planning it, trying it, observing the results, and acting on what
is learned. This is the scientific method used for action-oriented learning
References
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Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance.
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The Plan-Do-Study-Act cycle was developed by W. Edwards Deming (Deming WE. The New Economics for Industry, Government, Education.).