Orange Park Out-of-Hospital Quality Improvement Study for Improving CMS Sepsis Core Measures

Orange Park Medical Center66 enrolled

Overview

The goal of this quality improvement study is to measure the impact of incorporation of a manual rapid fluid infuser (RFI) for intravenous crystalloid infusion in patients with suspected sepsis in the prehospital interval. The main question\[s\] it aims to answer are: * Does the intervention affect the timeliness of fluid administration? * Does the intervention affect CMS sepsis bundle care measure compliance? * Does the intervention affect processes and outcomes of care? * Are there any adverse effects? Researchers will compare this intervention to use of more conventional gravity or pressure-infusion bag crystalloid infusion.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

Conditions

Sepsis Emergency Medical Services Quality Improvement Shock, Septic

Interventions

Incorporation of Rapid Fluid Infusion Device in Prehospital Suspected Sepsis ProtocolOTHER

Modified protocol specifying intravenous crystalloid infusion Rapid Fluid Infusion Device. The protocol states that for patients meeting the sepsis alert criterion, EMS will provide basic medical care, oxygen, a 12-lead electrocardiogram, attempt placement of an IV catheter and initiate administration of 30mL/kg of fluids.

Conventional Prehospital Suspected Sepsis ProtocolOTHER

Conventional protocol employing intravenous crystalloid infusion via gravity or pressurized-bag. The protocol states that for patients meeting the sepsis alert criterion, EMS will provide basic medical care, oxygen, a 12-lead electrocardiogram, attempt placement of an IV catheter and initiate administration of 30mL/kg of fluids.

Outcomes

Primary Outcomes

Percentage compliance with the CMS 3-hour sepsis bundle criterion (SEP-1) for patients with suspected sepsis

As defined according to the Centers for Medicare and Medicaid Services (CMS) Specifications Manual for Hospital Inpatient Quality Measures, version 5.9. "Time of presentation" or "time-zero" was defined as the time of triage in the Emergency Department. All patients enrolled in the study were assessed for measure compliance, without application of measure inclusion/exclusion criteria.

Time frame: Assessed at 3 hours after ED arrival

Secondary Outcomes

Percentage achievement of 30mL/kg crystalloid infusion for hypotension or lactate level > 4 mmol/L at 1 hour

Dichotomous measure of whether infusion volume was met, based on sum of prehospital and ED-based crystalloid fluid infusion

Time frame: Assessed at 1 hour after ED arrival

Total volume of intravenous crystalloid infused by time of ED arrival

Time frame: During the 3 hours prior to ED arrival, while under care by EMS.

Total volume of intravenous crystalloid infused by 1 hour after ED arrival

Time frame: Assessed at 1 hour after ED arrival

Total volume of intravenous crystalloid infused by 3 hours after ED arrival

Time frame: Assessed at 3 hours after ED arrival

Total volume of intravenous crystalloid infused, in the ED, by 1 hour after ED arrival

Time frame: Assessed at 1 hour after ED arrival

Total volume of intravenous crystalloid infused, in the ED, by 3 hours after ED arrival

Time frame: Assessed at 3 hours after ED arrival

Percentage of study participants receiving any intensive care unit care