Epidemiology and Microbiology of Sepsis Syndromes in a University-Affiliated Urban Teaching Hospital and Level-1 Trauma and Burn Center.

PURPOSE: To use the 2010 to 2011 data collected by structured chart review to provide a detailed up-to-date description of the epidemiology and microbiology of the sepsis syndromes. METHODS: Prospective observational study conducted at a university-affiliated urban teaching hospital and level-1 trauma and burn center. All adult patients who triggered a Code Sepsis in the emergency department (ED) between January 2010 and December 2011 were included. RESULTS: One hundred eighty four patients presented with a verified sepsis syndrome and triggered a Code Sepsis in the ED during the studied time period. The mean hospital and intensive care unit length of stays (LOSs) were 15.4 (interquartile range [IQR] = 14) and 6.7 (IQR = 5) days, respectively. The total inpatient mortality was 19% (n = 35). Patients with an unspecified source of infection and those without an isolated pathogen had the highest inpatient mortality, 42.1% (n = 8) and 23.3% (n = 10), respectively. CONCLUSION: Hospital mortality and hospital LOS of sepsis are similar to those reported in other observational studies. Our study confirms a decline in the mortality of sepsis predicted by earlier longitudinal studies and should prompt a resurgence of epidemiological research of the sepsis syndromes in the United States.

Multidisciplinary approach to improving pain management.

On a 30-bed trauma surgical unit in an academic medical center, a best practice group was established. For a first project, we worked on improving the patient's pain experience. The decision was driven by the units Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) pain scores. We had consistently been in the 1st percentile whereas best practice hospital scores were in the 68th percentile for pain. In addition, patients were expressing dissatisfaction with pain care during wound care with physicians. We reviewed the HCAHPS scores and brainstormed possible factors leading to patients' dissatisfaction with their pain care. Staff developed a teaching tool, which included a communication plan for the individual patient's pain plan. Next, we addressed the wound care with the trauma surgeons to develop a better understanding of the problem and identify a solution. The best practice group collaboration meeting became a springboard to address the pain issue for surgical patients through their hospital stays. The nurse manager, educator, pain relief attendant, anesthesia attendant, and 2 trauma surgeons met to discuss how to improve the surgical patient's pain experience. This trauma surgical unit now exceeds the top performers in HCAHPS scores. We have moved from the 1st percentile to the 90th percentile in 5 months.