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
18
ICU ED
Role of Collaboration
19
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.
4153
29
48
28 2720
30
0
20
40
60
Sebat Kortgen Shapiro Micek
Mor
talit
y (%
)
Control
Protocol
*
†
* *
‡ ‡
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
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