HALT Sepsis – Think Sepsis First!

Providence Sacred Heart Medical Center (Spokane, Washington)

CSI Summary

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CSI Presentation

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CSI Toolkit

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Project Topic

Improving early recognition and communication of sepsis signs/symptoms to decrease sepsis mortality and ICU transfers

Hospital Unit

Cardiac Medical 9N

CSI Participants

Alyssa Boldt, BSN, RN, PCCN
Sarah Cole, BSN, RN, PCCN

Project Goals/Objectives

  1. Decrease length of stay 0.6 days (10%)
  2. Decrease monthly ICU transfers by one patient (approx. 10%)
  3. Increase staff confidence in early sepsis recognition in 75% of nurses surveyed

Project Outcomes

  1. Decreased patient length of stay 0.54 days for patients with septic shock and 0.26 days for patients with severe sepsis
  2. Decreased the monthly average number of ICU transfers 7.2% in the six months prior to COVID-19, with an overall 2% decrease in monthly transfers over the project duration
  3. Increased staff confidence in communicating septic patient decline to a physician 34.1%
  4. Increased staff confidence in early recognition of sepsis in 50.8% of nurses surveyed

Project Overview

Our organization recognizes that sepsis is a leading cause of death in hospitals and that delays in treatment significantly impact survival rates. To support improved sepsis outcomes, our CSI team – nurses in a newly-christened sepsis (telemetry) unit – identified the need to help direct care nurses become more proficient in early recognition of the signs and symptoms of sepsis, and improve their communication of these signs and symptoms to the multidisciplinary team.

Knowing that use of SBAR tools can improve patient safety, our CSI team created a sepsis-specific SBAR tool for our unit. We also developed a mnemonic, “HALT Sepsis: History, Assessment, Labs and Trends,” and created a visual tool to keep the mnemonic top-of-mind for nurses. In addition, we provided concurrent one-on-one education sessions about the SBAR and HALT tools.

Implementation of these tools resulted in both decreased patient transfers to the intensive care unit and increased staff confidence levels with early recognition of sepsis. Our average length of stay also decreased, yielding a projected yearly savings of $650,792. In addition, we measured expected vs. observed (O/E) mortality rates. The overall ratio did not change; however, we saw a significant decrease in severity of sepsis cases, suggesting that severely ill patients were identified by the charge nurse before being admitted to a lower acuity unit and were sent to a more appropriate level of care.

Our team’s next steps include continuing education in the form of additional simulations of varying complexities for staff members on 9N. And our HALT tool is easily transferrable to other units, so we hope to expand its use in the future.

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The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.

The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.