Sepsis Case Study Essay

Sepsis has gained much focus as a major global health problem. Since 2003, an international team of experts came together to form the Surviving Sepsis Campaign (SSC), in the attempts to combat an effectively treat sepsis. Although, diagnostics and protocols have been developed to identify high risk patients, the need for human clinical assessment is still necessary to ensure a proper diagnosis is made and appropriate treatment is initiated in a timely manner. The use of a highly efficient and experienced team, such as, the electronic Intensive Care unit (eICU) could close the gap from diagnosis to treatment.

Clinical Practice Question

Will implementing sepsis screening by the eICU for ICU and Step-down units improve earlier diagnosis and treatment of sepsis compared to waiting for admitting physician to assess the patient?

Critical Appraisal Components

1st Critical Appraisal Component in CETEP Model Evidence-Based Factors:

Research

In 2015, Badawi and Hassan authored a study known as the, Telemedicine and the Patient with Sepsis, which, identified sepsis as being a under-identified event in the ICU.

Sepsis was associated with high mortality rates due to delay in diagnosis and treatment. The study was performed over 3 years in an ICU setting, screening over 68,000 patients, which, identified 5437 cases of severe sepsis (Badawi & Hassan, 2015). The article further discusses how tele- ICU’s can support and improve patient outcomes by screening for systemic inflammatory response syndrome (SIRS), prior to a patient developing severe sepsis. Moreover, screening is considered a vital component to improve survival rates in sepsis; screening gives promise to patients of early intervention and improved outcomes (Badawi & Hassan,

2015).
Although, technology has given us a tool in identifying signs and symptoms to screen for sepsis, computers do not have the ability to correlate the clinical assessment needed to appropriately diagnose severe sepsis (Badawi & Hassan, 2015). Overall, the article stipulates implementation of standardized protocols can be accomplished through the use of a telehealth team with adequate training and focused experience. The article further reveals how the involvement of a tele-ICU has proven to improve timely diagnosis and treatment, therefore, improving patient outcomes (Badawi & Hassan, 2015)..
In the article, Standardizing Sepsis screening and Management via a Tele-ICU Program Improves Patient Care, the authors concur with the previous study but acknowledge that evidence based treatment is as equally important. Rincon, Bourke and Seiver 2015, identified aggressive evidence based treatment initiated by the tele-ICU can improve patient outcomes by implementing treatment prior to the patient being seen by a bedside physician. This study was done out of Sutter Health in North Carolina and consisting of 161 ICU bed from 10 hospitals. The acuity level ranged from large tertiary care centers to rural/small institutions limited to specialty physicians. The study was performed between 2006- 2008 and results showed “patients were more likely to receive timely antibiotic administration, have a lactate level measured, received the initial fluid bolus, and have central line placement” (Rincon, Bourke, & Seiver, 2011, p. 562), quicker when the use of a tele-ICU was implemented rather than not.
Complex diagnoses require highly trained specialized care providers in order to manage the treatment in an ICU or stepdown unit (SDU). Unfortunately, shortage of critical care nurses and intensivist are at an all-time high and are expected to increase (Rincon et al., 2011). To combat the shortage, technology has developed tools and resources to assist in the care of the critically ill. The tele-ICU is made up of specialized experienced nurses and physicians which, monitor anywhere between 30-40 patients each. These care providers can efficiently screen and assess patients via video telecommunications. This framework although does not increase the nursing workforce, it does close the gap of providing experienced resources and interventions for the bedside caretakers (Rincon et al., 2011). Having the Tele-ICU as a resource to overview the screening and diagnosis of sepsis has proven to reduce the time of treatment and improve overall patient outcomes (Rincon et al., 2011). Ultimately, having a resource of highly experienced, knowledgeable individuals has shown to increase the survival rates of the critically ill.
These two studies support the implementation of automated screening tools as an adjunct to the implementation of the tele-ICU as a form of identifying and treating patients with SIRS or sepsis. The tele-ICU has proven to be a resource that gives great advantage for patients being monitored in ICU as well as in step down units (SDU). As healthcare evolves, implementing technology and clinical assessment as a form of patient management has improved patient outcomes and surviving complex diagnoses.
2nd Critical Appraisal Component in CETEP Model Clinical Setting Factors:
Clinical Expertise
Baptist Health of South Florida (BHSF) is fortunate to have a Tele-ICU which consists of experienced critical care intensivists and nurses. This tele-ICU covers approximately 160 beds consisting of ICU and SDU beds. The staff in this department has an average of 15+ years’ experience and 50% of them are certified nationally by the American Association of Critical Care Nurses (AACN) as Critical Care Nurses (CCRN). This level of ICU knowledge combined with advanced technology of video monitoring provides a resource with a high level of expertise to the bedside.
Furthermore, the availability of this highly concentrated resource is only a push of a button away. Care for the patient, is immediate and lag time for call backs from bedside physicians has been virtually eliminated. Sepsis screenings are reviewed by the tele-ICU care-providers with an immediate diagnosis and timely intervention. In essence, patient outcomes have shown to improve with timely, efficient and appropriate treatment.
Conclusion
In summary, sepsis is a complex diagnosis that requires a specialized trained individual that can identify and diagnosis its symptoms. Technology has provided devices for healthcare providers to identify such elusive findings in the form of screening tools. Therefore, combining technology with experience has ultimately shown to improve patients’ outcomes and survival rates, in the treatment of complex ICU and SDU patients.