Characterizing a High-Reliability Implementation Program for Sepsis: Sepsis Tools AND Accurate Reporting of Outcome Differences (STANDARD) Study - PROJECT SUMMARY Sepsis is the most common cause of death in U.S. hospitals, and hospital risk-adjusted sepsis mortality varies by more than 40%—suggesting that an estimated 20,000 sepsis deaths could be avoided if top-performing sepsis care were delivered more widely. Sepsis quality improvement activities have focused on reducing variation in early clinical care, but the ways in which performance improvement (PI) is implemented vary widely. Trauma systems and other disease-specific regionalization programs have achieved impressive mortality reduction through standardized implementation of PI. The overall objective of this project is to identify organizational features and PI implementation practices likely to reduce sepsis mortality and then to validate that these practices are associated with improved outcomes. Our central hypothesis is that PI implementation practices (e.g., multidisciplinary sepsis committee, case review, use of an institutional sepsis registry) observed in top-performing hospitals can be adapted and widely applied to lower-performing hospitals to improve sepsis clinical outcomes. The specific aims of the proposed study are to (1) identify hospital-level implementation strategies and PI activities being used in top-performing hospitals, (2) validate the relationship(s) between specific implementation strategies and sepsis performance, and (3) develop consensus regarding implementation strategies most likely to be impactful in lower-performing hospitals using a community-engaged approach. The proposed project will accomplish these aims by (1) conducting site visits at 10 top-performing hospitals and 6 lower-performing hospitals identified based on hospital risk-adjusted sepsis mortality and performance on the sepsis quality reporting metric (SEP-1); (2) identifying PI implementation strategies that are related to low sepsis mortality; (3) conducting an inventory of PI activities identified in site visits in a national sample of 560 hospitals to measure the association between PI and clinical outcomes; (4) identifying those strategies most strongly associated with improved clinical outcomes; and (5) convening a panel of experts with practical knowledge and experience to identify strategies using a modified Delphi method that are most promising to implement feasibly in lower-performing hospitals. After successful completion of the proposed project, we expect to have identified organizational features and successful PI implementation strategies at top-performing hospitals (Aim 1) and validated those strategies in a larger sample of U.S. hospitals (Aim 2). Then we expect to have identified the most promising among those strategies for future implementation (Aim 3). These results will have a positive impact because they will serve as an important resource for developing best practices for sepsis PI implementation that have the potential to improve hospital performance and therefore reduce preventable sepsis deaths.
