Forming an Innovative Healthcare Team to Promote a New Approach to a Current and Ongoing Healthcare Issue

Sepsis is a major public health concern in the U.S., where it contributes to over one million hospitalizations annually, of which around 25% are fatal (CDC, 2024). Evidence-based methods to identify sepsis are still not fully effective. This is due to a lack of communication among caregivers and insufficient steps to improve the situation. The process of addressing this gap must be systematic and involve multiple professions. Evidence-based practice synthesizes the available evidence and research with patient needs (Tenny & Varacallo, 2024). This assessment will form an interprofessional team, define four provider roles in sepsis management, review two sepsis management research articles, and create team-based recommendations to resolve the problem.

Healthcare Issue

Sepsis is a major global health problem because of its burden on morbidity and mortality in all health systems. Sepsis occurs when patients have organ dysfunction due to the uncontrolled response to an infection by the host. Inadequate diagnosis due to poor consensus around the operationalization of the Sepsis-3 guidelines in clinical practice continues to contribute to variability in real-world identification of Sepsis. The delay in administration of the first dose of antimicrobial treatment worsens patient health outcomes, including death; therefore, identification of Sepsis must be done urgently. The SEP-1 (“Severe Sepsis and Septic Shock”) bundle prescribes the timely delivery of goal-directed therapy by defining the components of the bundle, which include blood cultures, lactate, broad-spectrum antibiotics, and fluid resuscitation. The SEP-1 bundle describes the components of the bundle that every hospital should have, but compliance with the SEP-1 bundle is still a prevalent issue.

Sepsis costs the U.S. economy billions of dollars annually and is considered one of the pressing concerns of public health by the CDC and thus demands intervention to improve the quality of care provided for sepsis response across the U.S. In response, hospitals will be obligated to use fully integrated inter-professional models of collaborative practice to resolve issues related to delivering care for sepsis patients and the optimization of clinicians’ adherence to evidence-based practice protocols through the use of multidisciplinary huddle models (Currie et al., 2023). Evidence-based strategies to address the challenge of delay in diagnosing sepsis will be used to guarantee delivery of care to patients with sepsis at the needed time and the optimal care.

Roles and Perspectives

There are four healthcare workers who will provide an evidence-based approach to the management of sepsis. They are members of the multidisciplinary team, which comprises an emergency department physician, a critical care advanced practice registered nurse (APRN), a clinical pharmacist, and a clinical nurse informatician. The emergency department physician will provide care in the initial phase of the management of sepsis. This will include ordering blood cultures and lactate, and establishing vasopressors and fluids per the Surviving Sepsis Campaign guidelines (Centers for Disease Control and Prevention, 2024). 

The emergency department physician will communicate using SBAR (situation, background, assessment, and recommendation). This specialist will consider all team members’ clinical judgment for each patient. The critical care APRN will provide hands-on patient care and will provide early recognition of “red flags,” and will provide communication to the nursing staff and the physician during the treatment of the patient. Nurses participating in organized sepsis programs maintain confidence when discussing objective data and vital signs with physicians (Gustad et al., 2024). The APRN will educate the patients and their families. Clinical pharmacists provide expertise in antimicrobial stewardship and the appropriate selection of initial broad-spectrum antibiotics and dose modification for patients with renal impairment.

Huddles undertaken by clinical pharmacists at the bedside have been shown to shorten door-to-antibiotic time (Currie et al., 2023). Clinical nurse informaticists build sepsis alerts in the EHR by increasing the sensitivity of alert systems and combating alert fatigue, and build real-time dashboards that show gaps in documentation.

Critical Appraisal of Studies

While improving quantitative elements is essential for the management of sepsis, human factors play a role in the treatment process as well. The aim of the study by Currie et al. (2023) was to examine the effects of the introduction of a multidisciplinary bedside sepsis huddle on the recognition of sepsis and adherence to the SEP-1 bundle in the emergency department using a retrospective, single-center cohort design. The research study defined both the problem and the importance of the study; however, the study objectives were not clear since the authors did not include a hypothesis. Therefore, the concern of temporal bias exists, and causality cannot be inferred from the study. 

The sample frame was 116 participants who were reviewed in the EHR and screened for inclusion. This makes the study consistent; however, it does limit the generalizability and may introduce some selection bias, since it is based on a single center. Use of objective documentation for data collection will improve the reliability of the study results. Incomplete medical records may compromise the data used in the study and may affect the data’s validity and the completeness of the study. The authors’ use of the logistic regression analysis was deemed accurate and provided statistically significant results for the implementation of the sepsis bundle and a significant improvement in the administration of antibiotics. It is important to note that the study did suffer from bias caused by the implementation of several types of changes and uncontrolled confounding. Overall, the study provides an excellent relationship of the intervention with the outcome, but does not have adequate generalizability.

Collaboration, communication, and education play significant roles in ensuring positive sepsis outcomes. Gustad et al. (2024) investigated the post-QI intervention experiences of nurses and doctors with respect to collaboration and communication. Given the post-intervention nature of the research question, it is justified for Gustad et al. to apply a qualitative research approach. Fifteen sample participants were nurses, and five were doctors. Focused sampling of participants across many hospitals in Norway yielded a small sample size of 13 nurses and 5 doctors. Data were collected from clinical personnel. However, purposive sampling may reduce the generalizability of the findings. 

The researcher confirmed qualitative rigor by conducting systematic text condensation and theme development. It should be noted that the researcher’s interpretation of data as well as the selection of participants may introduce bias to the findings. The authors indicate that the study is ethically appropriate since there was informed consent and respondents participated anonymously. Compared to Currie et al., this study does not include measurements of clinical outcomes. However, it does include useful information on the barriers and facilitators to accomplishing the aim of the sepsis intervention in practice.

Outcomes and solution

Solution: Create Selected Sepsis Alerts to Trigger Bedside Huddle. An evidence-based, EHR-enabled, multidisciplinary sepsis Bedside huddle has the potential to improve coordination and collaboration amongst all staff involved in the care of the patient, resulting in the identification of sepsis and the quick provision of the sepsis bundle. Other studies have shown an increase in patients fulfilling the criteria for the sepsis bundles, and an improvement in patient outcomes with a reduction in mortality rates and a decrease in length of stay. 

Once the sepsis alert is activated in the EHR, the physician, APRN, and Pharmacist will respond to the patient’s bedside within 5 minutes. The physician will confirm the diagnosis and dictate orders. The APRN will perform a focused assessment and obtain a lactate and blood cultures. The Pharmacist will order the appropriate empiric antibiotics based on the patient’s renal function.

A pre-populated order set along with a real-time dashboard will allow for the documentation of SEP-1 bundle components at the appropriate time. The goal for this project is to achieve a decrease in door-to-antibiotics time, increased compliance with the SEP-1 bundle, and, as a result, a reduction in sepsis-related deaths and length of stay. According to Currie et al. 2023, the study huddle model saw an improvement in responsible antibiotic use, meeting the compliance goals, from 33% to 90%, in one hour. Gustad et al. 2022 showed a model for sepsis-specific rapid response teams (SARRTs) to improve the initiation of sepsis bundles and a focus on patient outcomes.

In 2024, it was hypothesized that the use of interprofessional collaboration within an established framework would yield trust and role clarity leading to the sustainability of the program. It is anticipated that the successful implementation of the program will require continuous education for all staff, a commitment by the administration to provide pharmacists and advanced practice registered nurses to cover the huddle activation, a monthly meeting of the informaticist to review data to circle the gaps and reinforce the rules, and adapt the huddle protocol according to the ongoing evidence and priority of the organization. It is anticipated that with commitment from the administration and continuous education and training for staff, the measures previously outlined will promote the sustainability of the program.

Conclusion

Time is critical for sepsis. Due to the complex presentation of sepsis, a variety of healthcare professionals must work together; this is achieved through a formal huddle at the patient’s bedside. A formal huddle is a formal process for staff to come together at the patient’s bedside. In the studies reviewed, a formal huddle process, when implemented, increased compliance with bundle protocols and improved the timeliness of antibiotic administration. There are multiple studies that support the benefits and positive effects of conducting a formal, interprofessional huddle during the management of sepsis.

References

Centers for Disease Control and Prevention. (2024). Hospital sepsis program core elements. Sepsis. https://www.cdc.gov/sepsis/hcp/core-elements/index.html

Chen, J., Fang, X., Liu, W., Huang, C., & Dai, Y. (2024). Exploring factors influencing delayed first antibiotic treatment for suspected early-onset sepsis in preterm newborns: A study before quality improvement initiative. BioMed Central Pediatrics, 24, 407. https://doi.org/10.1186/s12887-024-04887-9

Currie, K. E., Barry, H., Scanlan, J. M., & Harvey, E. M. (2023). Impact of a multidisciplinary sepsis huddle in the emergency department. The American Journal of Emergency Medicine, 64, 150–154. https://doi.org/10.1016/j.ajem.2022.12.006

Gerard, R., Dewitte, A., Gross, F., Pradeu, T., Lemoine, M., Goret, J., & Matsuda, M. M. (2025). Is “pre-sepsis” the new sepsis? A narrative review. Plos Pathogens, 21(7), e1013372. https://doi.org/10.1371/journal.ppat.1013372

Gustad, L. T., Bangstad, I.-L., Torsvik, M., & Rise, M. (2024). Nurses’ and physicians’ experiences after implementation of a quality improvement project to improve sepsis awareness in hospitals. Journal of Multidisciplinary Healthcare, 17, 29–41. https://doi.org/10.2147/jmdh.s439017

Kim, H.-J., Ko, R.-E., Lim, S. Y., Park, S., Suh, G. Y., & Lee, Y. J. (2024). Sepsis alert systems, mortality, and adherence in emergency departments. Journal of the American Medical Association Network Open, 7(7), e2422823. https://doi.org/10.1001/jamanetworkopen.2024.22823

Tenny, S., & Varacallo, M. (2024). Evidence-based medicine (EBM). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470182/