Quality improvement model (IHI) as a strategy to implement a sepsis protocol in a public hospital in Brazil

• Main Authors: Leidy Katerine Calvo Nates, Antônio Capone Neto, Adriano José Pereira, Eliézer Silva, Guilherme de Paula Pinto Schettino, Ana Paula Metran Nascente Pereira, Adolfo Wenjaw Liao, Midgley Gonzales, Rosana Mandelbaum, Fernanda Domingos Giglio Petreche, Cristina Tiemi Amadatsu, Carolina Devite Bittante, Leonardo Jose Rolim Ferraz, Carlos Alberto Eduardo Gomes, Rodrigo Vone Fregoneze, Rodrigo NG Taniguchi, Gabriela Sato, Marcia Galluci Pinter, Adriana Martins da Silva, Maitê Augusta C C Rossetto, Eliton Paulo Leite Lourenco, Samira Scalso de Almeida, Silvana Aparecida Eleodoro dos Santos, Marcelo Longarezi Valvassora, Maria Aparecida Machado, Caroline Gusmão Alves Santos, Camila de Carvalho Gambin, Natalia Nunez de Souza, Priscilla Santini Ramalho, Érika Brosco Lima, Maria Caroline de Oliveira, Andreza Moreira Santana, Andreza Michele Secolo, Denise Simas Lamarão, Francisco Neves Pereira, Ana Paula Doria Santos, Claudia Regina Basilio Foglietto, Priscila Reimão de Melo Fortunato, Ernane Cruz da Silva, Ana Paula de Oliveira Ribeiro
• Format: Article
• Language: English
• Published: BMJ Publishing Group 2020-03-01
• Series: BMJ Open Quality
• Online Access: https://bmjopenquality.bmj.com/content/9/1/e000354.full

A major challenge for hospitals in low-income and middle-income countries is to improve management of patients diagnosed with sepsis. The objective of the present study was to evaluate the Institute for Healthcare Improvement (IHI) Model as a strategy to implement a managed sepsis protocol aimed at reducing sepsis mortality. We performed a longitudinal, prospective, non-randomised study using PDSA cycles for translating and implementing improvement actions and tools. Baseline case mortality/case fatality data were collected, and compliance rates were evaluated according to the Surviving Sepsis Campaign guidelines (3-hour care-bundle). Sepsis multidisciplinary work teams were designated and were responsible to develop Driver Diagrams and implement process changes in the intensive care unit, wards and emergency department. Satisfaction levels of healthcare professionals were assessed (balance variables). The study was carried out in a public quaternary hospital, in São Paulo city, Brazil (Hospital Municipal da Vila Santa Catarina). The number of patients with sepsis studied was 416 who were followed over a 15-month period. The data analyses were carried out by statistical process control. Case fatality rates were kept below a prespecified target of 25% (15.9%) during the period. Satisfaction level of the participating staff was high (95.2%) and 71% of participants reported no work overload. The IHI model was found to be a feasible and useful strategy for implementing a sepsis management clinical protocol.