Implementation of the National Early Warning Score for Sepsis Screening

Abstract

Problem & Purpose: Sepsis is a complex syndrome that bears high morbidity and mortality. Sepsis that remains undiagnosed before admission is associated with increased costs and mortality rates. An audit of emergency department (ED) practices within a 244-bed military tertiary medical center found that a systemic inflammatory response syndrome-based tool was being utilized to identify patients with possible sepsis. Studies demonstrate this tool has poor prognostic accuracy and utility in triage, therefore making it an inferior method of sepsis screening. This quality improvement initiative implemented a National Early Warning Score (NEWS)-based sepsis screening tool for adults presenting to the ED to improve sepsis identification and delivery of sepsis core measures. Methods: Adult ED patients were screened for sepsis during triage utilizing a nurse-driven electronic tool. Positive screenings triggered initiation of a sepsis bundle. Manual chart abstraction was used to calculate screening rates and sepsis core measures of time-to-lactate and time-to-antibiotics in minutes. Data were analyzed using descriptive and independent samples ttest statistics to determine the association between screening and sepsis core measures. Results: Overall, the compliance rate for sepsis screening was 81% (n = 912). A comparison of baseline (n =12) to post-implementation data (n = 25) displayed a significant decrease in the delivery time of sepsis core measures. Time-to-lactate significantly decreased (M = 85.76, SD = 29.15) compared to baseline (M = 184.17, SD = 120.99); t(12) = 2.78, p = 0.02. Time-toantibiotics also significantly decreased (M = 110.21, SD = 46.04) compared to baseline (M = 231.73, SD = 145.57); t(11) = 2.71, p = 0.02. Conclusions: Use of a NEWS-based sepsis screening tool during triage facilitates the identification of patients at-risk for sepsis and improves the delivery time of sepsis core measures. Sepsis screening tools should utilize readily accessible data and be integrated into the electronic health record to ensure compliance and sustainability.