Reducing Sepsis Hospitalisations through a Standardized Quality Improvement Program in Skilled Nursing Facilities

Context: Sepsis hospitalisations with subsequent skilled nursing facility (SNF) admissions have had an annual cost of $41 billion in the United States. There has been a limited amount of literature on early interventions for sepsis in long-term care. Objective: To assess the impact of a pilot sepsis quality improvement program (SQIP) aimed at early identification and intervention in 10 partnering SNFs in New York City. Methods: Obtained baseline data of sepsis hospitalisations in 2017 among 10 SNFs. A SQIP was implemented utilizing the systemic inflammatory response syndrome criteria with a modified threshold temperature of 37.2°C (99.0°F). Sepsis hospitalisations were reported and validated for the intervention period in 2018 and compared to the baseline. A cost savings analysis was completed by utilizing local hospital billing records. Findings: Overall, there was a reduction of 54 sepsis hospitalisations when comparing the intervention period (183 sepsis hospitalisations) to the baseline (237 sepsis hospitalisations), a 22.8% decrease (p < 0.001). The initial SQIP costs were $45,000 USD. The SQIP had an estimated cost savings between $1,039,662–$3,188,430 USD. Limitations: Implementation at each facility was voluntary, so there may have been varying degrees of SQIP implementation. However, the hospital primary diagnosis of sepsis and cost were accurately reported. Implications: A SQIP in a long-term care setting could reduce avoidable hospitalisations and offer cost savings. The SQIP reported is a complex intervention and needs to be methodologically understood as such. The intervention shows promise and important insights into its implementation and evaluation have been developed which would be helpful in further evaluation.