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. 2025 May 28;13(11):1273.
doi: 10.3390/healthcare13111273.

Impact of a Sepsis Quality Improvement Initiative on Clinical and Operational Outcomes

Christopher B Thomas  1   2   3 , Benjamin Wyler  4 , Claude M D'Antonio  5   6 , Mark Laperouse  5   6 , Shannon Alwood  5   6 , Kristen Richard  5   6 , Alyse Grantham  5   6 , Roya Sheybani  7 , Matt G Sorrells  7 , Wei-Jien Tan  7 , James W Teague  8 , Hollis O'Neal  1   2   3 , Tonya Jagneaux  1   2
Affiliations

Impact of a Sepsis Quality Improvement Initiative on Clinical and Operational Outcomes

Christopher B Thomas et al. Healthcare (Basel). .

Abstract

Background/Objectives: Sepsis is a costly and life-threatening condition caused by a dysregulated host response to infection. Lack of a reliable, timely diagnostic for sepsis leads to under- and overdiagnosis, suboptimal outcomes, and strained hospital resources. Our Lady of the Lake Regional Medical Center (OLOLRMC) implemented a sepsis learning health program to evaluate and improve outcomes through standardized ED workflows and the incorporation of a novel sepsis diagnostic test. Methods: We report the results of the first year of experience following the implementation of the learning health initiative and sepsis testing. Data from the Epic EHR were analyzed across two groups: pre-implementation (April 2023-July 2023) vs. post-implementation (August 2023-July 2024), and temporally matched cohorts (April-July 2023 vs. April-July 2024). We assessed clinical outcomes (sepsis-associated mortality, hospital length of stay, or HLOS), and resource utilization (antibiotic use, blood cultures). Results: Post-implementation, sepsis-associated mortality dropped from 10.9% to 6.6% in the temporally matched group (p < 0.001). There was also a 0.76-day reduction in mean HLOS among sepsis DRG patients (p < 0.05). Blood culture utilization fell from 50.8% to 45.7%, driven by reductions in blood culture utilization among patients receiving a Band 1 IntelliSep score. Conclusions: The FMOLHS experience demonstrated significant benefits to patient outcomes and resource utilization after implementing a sepsis QI initiative including protocolized and standardized ED workflows via a nurse-driven triage system with sepsis testing for the early risk stratification of patients who present to the ED with signs and symptoms of infection.

Keywords: antibiotic stewardship; blood culture; deformability cytometry; emergency department; healthcare utilization; host response; length of stay; quality improvement; risk stratification; sepsis.

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Conflict of interest statement

B.W., C.M.D., M.L., K.R., A.G., H.O., and T.J. have hourly consulting agreements with Cytovale, Inc. R.S., W.-J.T., and M.G.S. are employees of Cytovale, Inc. C.B.T., S.A., and J.W.T. declare no competing interests. Although this study was designed and implemented by Our Lady of the Lake Regional Medical Center (OLOLRMC) as an un-funded quality improvement initiative, Cytovale assisted in the analysis of data and writing of the manuscript.

Figures

Figure 1
Figure 1
Patient groups for analysis.
Figure 2
Figure 2
Monthly distribution of our practice advisory (OPA) activations by type: primary/triage, secondary/physician, or both. The overall rate of activations increased slightly over time, driven by an increase in triage activations. The red vertical line marks the implementation date (August 2023).
Figure 3
Figure 3
Thirty-day survival probability by the ISI band. (a) All-cause in-hospital mortality and (b) sepsis-associated mortality post-implementation. Patients receiving a Band 3 ISI score had a significantly higher rate of mortality than those receiving a Band 2 or Band 1 score.
Figure 4
Figure 4
Impact on sepsis-associated mortality. Both the post and matched cohorts showed a decrease in the rate of mortality among sepsis DRGs.
Figure 5
Figure 5
Monthly rate of culture utilization. There was a significant reduction in blood culture utilization in the post-implementation period. The red vertical line marks the implementation date (August 2023).
Figure 6
Figure 6
Monthly blood culture utilization by ISI band. Post-implementation trends after August 2023 showed a significant decline in blood culture orders in patients receiving a Band 1 score, while there was a transient decline in blood culture utilization in those receiving a Band 2 score, and an increase in those receiving a Band 3 score.
Figure 7
Figure 7
Rate of antibiotic utilization stratified by ISI band. Antibiotic utilization was highest in patients receiving a Band 3 ISI score, slightly lower in those receiving a Band 2 score, and much lower in those receiving a Band 1 score.
See this image and copyright information in PMC

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