Objective: This article evaluates the feasibility of a tele-intensive care unit (ICU) nurse-driven early identification and treatment process for severe sepsis patients in improving compliance to evidence-based practice. Materials and Methods: Florence Nightingale identified that by using science, logic, and compassion to manipulate the patient care environment nurses could create the best possible conditions for healing to occur. Nurses in a tele-ICU used this premise to initiate a standardized screening and data collection program using a custom-built document sharing application that conformed to the Surviving Sepsis Campaign (SSC) criteria for identification and treatment of severe sepsis. Results: The tele-ICU nurses performed 89,921 screens on 36,353 ICU admissions to 161 ICU beds across a geographical range of 500 miles. Between January 1, 2006 and December 31, 2008, tele-ICU nurses identified 5,437 patients as meeting the criteria for severe sepsis. Statistically significant increases in compliance with SSC's bundled care recommendations were realized during this study period with four initial elements: antibiotic administration increased from 55 in 2006 to 74 in 2008 (p=0.001), serum lactate measurement increased from 50 to 66 (p=0.001), the initial fluid bolus of ≥20 mL/kg increased from 23 to 70 (p=0.001), and central line placement increased from 33 to 50 (p=0.001). Conclusions: A tele-ICU nurse-driven process can prompt earlier identification and improve compliance to evidence-based practice bundles for complex disease states such as severe sepsis.
展开▼
