Conquering Sepsis Mortality: Teamwork Makes the Dream

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Christa A. Schorr RN, MSN, FCCMAssistant Professor of Medicine

Cooper Medical School of Rowan UniversityDirector of Databases for Quality Improvement and Research

Program Director of Critical Care Clinical Trials Cooper University Hospital

The Surviving Sepsis Campaign: results of aninternational guideline-based performanceimprovement program targeting severe sepsis

SSC North American SummitsUnderway 2007

Sepsis 2012: What's Hot and What's NotSponsored by: New Jersey Hospital Association

Establish teams locally

Alignment Identification Collaboration High performance

4 Phases of Teamwork

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Aligning the team

• Clarify values, purpose and vision• Set realistic, quantifiable

objectives• Clarify roles and responsibilities• Organize for effectiveness• Establish team guidelines

6

Establish an Aim Statement

Example:• By March 2013• Our team intends to improve time to

antibiotics for ED admissions to ≤3 hours• Improvement will be measured by a 25%

increase in antibiotic indicator compliance– (60% currently - goal 75%)

7

Multidisciplinary cross-departmental alignment

Will the teams be receptive?

Patrick Lencioni 2002

leadership

enthusiasm

No Egos

Conflict

resolution

competence

Trust

Develop Transform

Lead Follow

camaraderi

e

Identification phase

• Refine roles and responsibilities• Manage conflict, clarify expectations

and re-establish accountability• Promote and set team identity

Recruiting the team

Received 2008 AACN Excellence in Collaboration Award Multidisciplinary

Teamwork behaviors

• Leadership• Situational awareness• Workload management• Resource management• Briefings• Debriefings

Sehgal N et al J Gen Intern Med 2008 December; 23(12): 2053-2057

Manojlovich M and DeCicco, B. Am J Crit Care 2007

Value of nurses at the bedside

• Empower nurses to recognize and report severe sepsis

Collaboration phase

• Learn how each team performs best• Develop feedback paths• Promote increasing autonomy for

higher performance

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ICU ED

Role of Collaboration

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Effective interventions for change

• Active involvement• Audit and feedback• Local consensus process• Reminders-prompts• Interactive educational material• Interventions targeting barriers

Gross P. 2009. Jt Comm on Qual Improvement. 26(9) 547-553

FeedbackData - Data and more data

• Facilitate guideline recommendations• January 2005-March 2008• 15,022 subjects at 165 sites• Result:

– sustained continuous quality improvement

Critical Care Medicine. 38(2):367-374, February 2010

Critical Care Medicine. 38(2):367-374, February 2010

Protocols:Implementation Consistently Reduces Mortality

Sebat F, et al. Chest. 2005;127:1729-1743; Kortgen A, et al. Crit Care Med. 2006;34(4):943-949; Shapiro NI, et al. Crit Care Med. 2006;34(4):1025-1032; Micek ST, et al. Crit Care Med. 2006;34(11):2707-2713.

*P < .05 compared with control; †In-hospital mortality; ‡28-day mortality.

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Sebat Kortgen Shapiro Micek

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Control

Protocol

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Schramm GE Crit Care Med 2011 Vol. 39, No. 2

High performance phase

• Anticipate each other’s behavior and operate with extreme efficiency

• Encourage innovative thinking• Solve problems quickly• Practice team renewal

Celebrate -team renewal

DreamTeam + Plan = Success

Thank you