Article Text

0089 Sepsis 6 Bundle Delivery In The Emergency Department. Simulation And Video Feedback Enables Real Quality Improvement
  1. Julie Mardon
  1. University Hospital Crosshouse, Ayrshire and Arran, UK

Abstract

Background Sepsis 6 delivery is challenging in the undifferentiated ED patient. Despite a sepsis project team within the ED the compliance with the bundle had reflected the challenging nature of the task (a mean compliance of 20%). Our hypothesis for improvement was that a combination of process mapping and in situ simulation training coupled with immediate reflective video feedback could improve our ability to provide timeous delivery of antibiotics.

Aim 80% of patients with sepsis will have antibiotic delivery within 1 h of identification by august 2014.

Method Process Mapping identified the challenging parts of the process which were prioritisation of the septic patient and communication of sense of urgency with the team. A simulation scenario was designed to reflect these non technical skills as core learning objectives. Data sampling was randomised to 10 patients a week after the whole patient population was examined.

9 training sessions were delivered.

  • A High fidelity mannequin was used

  • Immediate Video debrief

  • Real multidisciplinary teams

  • Identify human factors in teams

  • Latent risks were discovered

  • Process evolution

Results The data collected was collated into run charts showing an improvement from 12% compliance to 80% compliance in sepsis 6 and antibiotics given within 1 h and average time to first antibiotics reduced from 90 min to 22 min. run charts are available to show significant shift in practice.

Next Steps

  • Show sustainability

  • Spread use of in situ simulation within quality improvement within trust

  • Spread to Forth Valley and Nationally

  • Recent national visit has requested national spread

  • Bring human factors training to every board in Scotland

Conclusions An in situ simulation training program as part of a quality improvement project can enable a shift in practice within a busy ED department. The aim of the project was successfully met.

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