HMS Sepsis Toolkit 

Developing Institutional Guidelines

• Develop institutional guidelines, locally adapted from national and example hospital guidelines, for identification and treatment of sepsis. If institution specific guidelines already exist, they should comply with the following:
  • Hospital onset sepsis – Institutional guidelines should include:
    • Standardized process for screening for sepsis upon presentation and throughout hospitalization
    • Clinical evaluation (labs, diagnostic studies, imaging etc.)
    • Antimicrobial selection
    • Source control
    • Fluid resuscitation (indications, contraindications, type, and volume of fluid)
    • Antimicrobial narrowing and stopping
    • Patient and family education on sepsis
    • Peri-discharge management
• Integrate recommendations into key processes within the healthcare system such as into order sets, individual orders, discharge planning/processes, required yearly education for staff, etc.

Guideline Implementation – Order Sets and Screening Processes

• Develop and implement order sets for management of sepsis
• Develop and implement sepsis screening process for early identification of sepsis upon presentations and throughout hospitalization.
• Explore training rapid response teams in sepsis recognition and care.
• Develop structures and processes to facilitate prompt delivery of antimicrobials.
• Develop a standardized process for sepsis management including:
  • Screening
  • Clinical evaluation
  • Diagnosis
  • Antimicrobial selection
  • Source control
  • Fluid resuscitation
  • Indications for treatment escalation
  • Antimicrobial narrowing and stopping
  • Patient and family/caregiver education
  • Peri-discharge management

Guideline Implementation – Multidisciplinary Handoffs & Discharge Practices

• Develop structures and processes to support effective hospital hand-offs in patients with sepsis.
• Develop processes to evaluate patients prior to discharge and refer to appropriate resources post discharge to support recovery from sepsis.

Guideline Implementation – Educating Providers and Patients/Families

• Educate providers, including hospitalists, internal medicine, family medicine, emergency medicine physicians, residents, advanced practice professionals (APPs), and nursing staff about sepsis, early identification, sepsis management, their role in team-based sepsis care and post sepsis syndrome.
• Provide written and verbal education on sepsis to patients and families. Education should include:  what is sepsis, increased risk for subsequent episodes of sepsis, when to suspect sepsis, when to seek evaluation for potential sepsis and post sepsis syndrome.
• During educational sessions, highlight HMS data, showing opportunities for improvement.
• Communicate and promote institution-specific guidelines with frontline providers, including physicians, APPs, nursing, and pharmacy to ensure use of recommendations (morning report, grand rounds, medical staff meetings, division meetings).
• Build systems that can help modify provider behavior. Examples include (but are not limited to): clinical decision support tools.
• Consider social factors in marketing guidelines to frontline providers. Highlight their participation in creation of the guidelines, and try to overcome viewpoints of loss of provider autonomy. Instead, emphasize improvement in quality and outcomes.
• Involve champions in the education and dissemination process.

Examples of Guidelines that could be locally adapted to your institution based on local needs, antibiograms, etc.:

• International Guidelines:
  • Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Critical Care Medicine.
  • Surviving Sepsis Early Identification of Sepsis on the Hospital Floors
  • Australian Commission on Safety and Quality in Healthcare – Sepsis Clinical Care Standard (2022)
  • NICE Guideline – Suspected Sepsis: Recognition, Diagnosis, and Early Management (Updated 2024)
• HMS Member Hospital Examples:
  • University of Michigan Health West Sepsis Algorithm Example
  • Corewell Health – Spectrum: Clinical Pathway – Sepsis, Severe Sepsis and Septic Shock (Adult Inpatient)
  • Henry Ford Health – Suggested Empiric Antibiotic Therapy Guidelines
• Other Institutional Guideline Examples:
  • Intermountain Healthcare Recognition and Management of Severe Sepsis and Septic Shock
  • University of Wisconsin: Sepsis: Diagnosis and Management – Adult – Inpatient/Emergency Department Clinical Practice Guideline
  • University of Nebraska Medical Center Antibiotic Recommendations for Sepsis & Septic Shock

Implementation Resources

• Society of Critical Care Medicine Diagnostic Excellence Program – Implementing the Hour-1 Bundle Using a Multiprofessional Approach
• State of Victoria, Australia – Implementing an Adult Sepsis Pathway Toolkit

Webinars

• Action: Hospital Sepsis Program Core Elements – A CDC Webinar Series (57:53)
  • From: CDC’s Project Firstline
  • Presenters: Ray Dantes, MD, MPH; Hallie Prescott, MD, MSc; Megan Cahill, DO, FACOEP; Errin Couck, BSN, RN; Michael W. Fill, DO, FACEP
  • CE Information: 1.0 CME, 1.0 CNE, 1.0 CPE, 0.1 CEU, 1.0 CECH
  • Session Overview: CDC experts and partners share insights on how to implement effective structures and processes to improve sepsis identification, management, and recovery.
• Education: Hospital Sepsis Program Core Elements – A CDC Webinar Series
  • From: CDC’s Project Firstline
  • Presenters: Ray Dantes, MD, MPH; Hallie Prescott, MD, MSc
  • CE Information: TBD
  • Session Overview: Discover the impact of sepsis education for healthcare professionals during onboarding and as an annual refresher.
• Data and Quality Initiatives: Addressing a Costly and Deadly Condition (44:21)
  • From: Sepsis Alliance Institute
  • Presenters: Hallie Prescott, MD, MCs; Scott Flanders, MD; Amy McKenzie, MD, MBA; John Syrjamaki, MPH.
  • Session Overview: This panel discussion reviews assay biological pathways, sepsis progression, and immune system collapse. It will explore the role of molecular diagnostics in sepsis workflow and how to implement effective sepsis protocols in the lab and hospital practice.
• Developing Systems for Rural Sepsis Care (54:33)
  • From: Sepsis Alliance Institute
  • Presenter: Nicholas Mohr, MD, MS
  • CE Information: 1.6 CNE, 1.25 CE for other healthcare professionals
  • Session Overview: This presentation will explain some of the barriers to sepsis care and the ways that systems of care can be developed to support rural patients in low-volume hospitals.
• Strategies for Improving Sepsis Care (53:43)
  • From: Sepsis Alliance Institute
  • Presenter: Kelly Nguyen, MSN, RN, PHN
  • CE Information: 1.6 CNE, 1.25 CE for other healthcare professionals
  • Session Overview: This training module is intended to help staff functioning in quality/performance improvement roles begin the process of sepsis quality improvement for their organizations.

Order Sets Examples

• Munson Hospital – Sepsis Order Set
• Munson Cadillac Hospital – Sepsis Positive Screening Nursing Orders
• Henry Ford Health: ED Sepsis Narrator
• Henry Ford Health: Early Treatment – Code Sepsis and Sepsis Narrator
• Example of Severe Sepsis Alert with SBAR Embedded

Handoff Examples (to be locally adapted by your institution based on local needs, antibiograms, etc.)

• Health Services Advisory Group – Post-Acute SBAR for Sepsis (for when a patient screens positive for sepsis)
• Australian Commission on Safety and Quality in Healthcare – SHARED Clinical Handover Poster
• Society of Hospital Medicine Learning Portal – HQPS Transitions of Care Series Learning Modules (Free)
• AHRQ – SBAR Tool
• AHRQ – I-PASS Tool
• The Joint Commission – 8 Tips for High Quality Hand-offs
• AHA Center for Health Innovation TeamSTEPPS – What is SBAR?
• AHA Center for Health Innovation TeamSTEPPS – Video Example of SBAR
• AHA Center for Health Innovation TeamSTEPPS – Video Example of IPASS Handoff

Healthcare Professional Educational Resources

• BMJ Best Practice: Sepsis in Adults
• CDC’s Get Ahead of Sepsis (GAOS) Healthcare Professional Information
• The Sepsis Alliance Institute Webinars
• End Sepsis Resources
• NHS England: Sepsis Awareness Resources
• SSC Adult Patients Resources | SCCM
• World Sepsis Day Pocket Cards for Medical Professionals (and other Resources)
• Surviving Sepsis Campaign: Guidance on the Guidelines and Bundle (video)
• Surviving Sepsis Campaign: The Hour One Bundle (video)
• Surviving Sepsis Campaign: Hour One Bundle Infographic and Pocket Card

Patient, Family, and Caregiver Resources

• CDC’s Get Ahead of Sepsis (GAOS) Patient Information
  • Emphasizes the importance of early recognition, timely treatment, reassessment of antibiotic needs, and prevention of infection.
• Sepsis Alliance Patient & Family Page
• Sepsis Alliance Virtual Connect Support Community
• International Sepsis Forum Brochure on: What is Sepsis?
• Michigan Medicine COVID-19 Caregivers Toolkit
• Henry Ford Health Sepsis Fact Sheet for Patients
• World Sepsis Day Pocket Cards for General Public
• Society of Critical Care Medicine and Sepsis Alliance: Life after Sepsis video

General

•  AHRQ Summit to Address Emergency Department Boarding

• • The AHRQ Summit to Address Emergency Department Boarding convened in October 2024 to engage public and private partners, including patients and consumers; clinicians; hospital and health system leaders; policymakers; experts in emergency medicine, behavioral health, and other medical specialties; and others to identify actionable hospital-level and health system-level solutions to address ED boarding systematically.

• Alberto, L. et al. Screening for sepsis in general hospitalized patients: a systematic review. J Hosp Infect 2017.
  • A systematic review of literature which found that paper-based, nurse-led screening tools for sepsis appear to be more sensitive in the identification of septic patients.
• Dale, C. et al. Order set usage is associated with lower hospital mortality in patients with sepsis. Crit Care Explorations 2023.
  • A retrospective, observational cohort study which found that the use of a sepsis order set(“Sepsis Management” order) was independently associated with lower hospital mortality in patients hospitalized with sepsis.
• Damiani, E. et al. Effect of performance improvement programs on compliance with sepsis bundles and mortality: a systematic review and meta-analysis of observational studies. PLoS One 2015.
  • Performance improvement programs are associated with increased adherence to resuscitation and management sepsis bundles and with reduced mortality in patients with sepsis, severe sepsis, or septic shock.
• Dooley, K. et al. Improving hospital sepsis care using PAs and NPs on a rapid response team. JAAPA 2022
  • Using a sepsis rapid response team with physician associates/assistants(PAs) and NPs improved hospital adherence to sepsis evaluation and order set use from 48% to 86%.
• Ju, T. et al. Sepsis Rapid Response Teams. Crit Care Clin 2018 .
  • Using hospital-wide initiatives consisting of multidisciplinary education, training, and specific resource utilization, such teams have been found to improve patient outcomes for patients at risk of having or who have sepsis.
• Singer, M. et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).JAMA 2016.
  • These updated Sepsis definitions and clinical criteria should replace previous definitions, offer greater consistency for epidemiologic studies and clinical trials, and facilitate earlier recognition and more timely management of patients with sepsis or at risk of developing sepsis.
• Tarabichi, Y.et al. Improving Timeliness of Antibiotic Administration Using a Provider and Pharmacist Facing Sepsis Early Warning System in the Emergency Department Setting: A Randomized Controlled Quality Improvement Initiative*. Crit Care Med 2022.
  • Display of an electronic health record–based sepsis early warning system–triggered flag combined with electronic health record–based pharmacist notification was associated with shorter time to antibiotic administration without an increase in undesirable or potentially harmful clinical interventions.
• Threat. D.L., et al. Improving sepsis bundle implementation times: A nursing process improvement approach. Nursing Care Qual 2020.
  • A Performance Improvement project focusing on implementing an ER Nurse Sepsis Identification Tool, leadership buy-in, and SIRS education led to a decrease in time to bundle compliance in the ED.
• Thursky, K. et al. Implementation of a whole of hospital sepsis clinical pathway in a cancer hospital: impact on sepsis management, outcomes and costs. BMJ Open Quality 2018.
  • Implementation of a whole hospital clinical pathway for the management of sepsis was associated with significant improvement in patient outcomes and reduced costs.